Kidney Failure and the Federal Government (1991) / Chapter Skim
Currently Skimming:
The Patient Population
The Patient Population
Pages 62-84
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 62... ...
Mortality data are presented for this population and for various patient subgroups. The chapter also includes projections of incidence and prevalence of treated ESRD patients to the year 2000.
|
From page 63... ...
Prevalence data are useful for evaluating the health effects of the disease on society, estimating the costs of providing health care services, and determining what resources and manpower are necessary to provide these services. INCIDENCE AND PREVALENCE The incidence and prevalence of Medicare ESRD patients have increased dramatically from the start of the Medicare ESRD program (Table 1-1)
|
From page 64... ...
30 Cal Q 0 10 a) By Primary diagnosis Diabetes Mellitus O ~ 1 ~ 1982 1983 1984 + Hypertension ~ Glomerulonephritis 1985 Year 1986 1987 1988 FIGURE 4-2 Number of ESRD Patients by Primary Diagnosis, 1978-88 NOTE: As of December 31.
|
From page 65... ...
After the introduction of the Medicare ESRD program in 1973, the number of newly treated patients increased dramatically. The age distribution of new patients began to shift upward; the proportion of new ESRD patients with chronic diseases such as diabetes mellitus and hypertensive vascular disease also began shifting upward.
|
From page 66... ...
Between 19821 and 1988, the reported number of new Medicare ESRD patients with diabetes as the primary cause of renal failure increased from 5,019 to 11,034 per year (USRDS, 1990) , an increase from 23 percent to 31 percent of all new patients.
|
From page 67... ...
67 oo oo Cal · C~ o s: ._ .c ~: Ct s~ ~: a' au C~ ~: Ct V)
|
From page 68... ...
The incidence of the underlying cause of ESRD also differs substantially among the principal gender-race subgroups (Table 4 51.2 Among white men, ESRD rates attributed to diabetes mellitus and hypertension are quite similar, with these two diagnoses accounting for the majority of patients. Diabetes mellitus is the most frequently reported underlying cause of ESRD among white women, with incidence rates nearly as high as among white men.
|
From page 69... ...
However, because of considerably higher mortality rates among elderly and diabetic ESRD patients compared to other age and diagnostic groups, both represent a considerably smaller proportion of the prevalent compared to the incident population. For example, in 1988 the incidence rate of diabetic ESRD was over twice that of glomerulonephritic ESRD, but the prevalence was very similar.
|
From page 70... ...
70 · c~ ct ·fi .c P" A: Ct Cal Ct a' Cal a' .
|
From page 71... ...
rate, defined as the rate of death in all patients treated for ESRD during a year, has been increasing over time. · Unadjusted mortality rates in incident cohorts, however, were stable during 1978-82, jumped upward from the 1982 to the 1983 incident cohort, and have remained fairly stable since then.
|
From page 72... ...
· International data show that the United States has higher gross mortality and adjusted mortality rates than some European countries, although these data must be interpreted cautiously because cross-national comparisons have substantial limitations. Unadjusted Mortality This section presents data for annual incident and prevalent cohorts of ESRD patients and discusses the effect of increasing incidence on temporal trends of unadjusted mortality.
|
From page 73... ...
1989a; USRDS, 1989, 1990~. Unadjusted mortality analyses indicate three things: First, in the period from 1978 through 1982, mortality was stable; second, an abrupt increase in recorded mortality occurred during the 1982-83 period; and third, mortality has remained fairly stable since 1983 (Table 4-7~.
|
From page 74... ...
Adjusted Mortality Although mortality rates of a patient population may change over time, the risk of death for particular groups of patients does not necessarily follow the same trend. Gross mortality for ESRD patients has increased over time, largely because of an increased proportion of higher risk patients, but there is no a priori reason to believe that the risk of death, for example, of a white male patient, age 45, with no major comorbid conditions, increased between 1978 and 1988.
|
From page 75... ...
Adjusted for Age, Race, Gender, and Primary Diagnosis, 1978-88 Patient Cohorts Adjusted Mortality (%) Year Incident Cohortsa Prevalent Cohortsb 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 21.0 20.3 20.1 20.9 20.7 21.7 21.6 21.6 21.1 21.5 20.6 13.8 13.5 13.9 14.2 13.2 13.2 19.0 13.8 13.7 13.6 13.7 aOne-year adjusted mortality calculated from day 91 to 1 year + 90 days for patients, by year of incidence of ESRD.
|
From page 76... ...
76 ._ o Ct Ct in ._ Ct Pa a V)
|
From page 77... ...
The investigators conclude: "If these trends continue, or if the most recent results are maintained, then future studies must confront the increase in mortality rates among center hemodialysis patients and determine its cause" (Wolfe et al., 1990, p.
|
From page 78... ...
78 Ct Cal Ct a' be ¢ C)
|
From page 79... ...
Those with two or more such risk factors increased from 59 percent to 72 percent: diabetics increased from 29 percent to 43 percent; and the percentage of patients over age 75 nearly doubled. Between 1982-84 and 1985-88, the average annual unadjusted mortality rate for all dialysis patients (hemodialysis and peritoneal dialysis)
|
From page 80... ...
The analysis reported 4-year cumulative survival in dialysis patients aged 15-44 years. This analysis points to effects of comorbid conditions, acceptance rates, and transplantation rates on survival rates in national populations.
|
From page 81... ...
Eggers, at the request of the IOM ESRD study, prepared an estimate of the Medicare ESRD patient population for the year 2000 for this study, updating previous projections (Eggers, 1989) by incorporating new information on incidence and mortality for dialysis as well as transplant patients.
|
From page 82... ...
Although these projections are unlikely to predict the future of the Medicare ESRD enrollment with precision, they provide a reasonable estimate of future enrollment based on current treatment and outcome trends. Even the low scenario indicates that historical growth of the ESRD population will continue well into the next century, as shown in Figure 4-3.
|
From page 83... ...
5. Gross mortality may have been increasing since the inception of the Medicare ESRD program, with the increase of older patients and patients with chronic diseases such as diabetes.
|
From page 84... ...
1990. Mortality rates among dialysis patients in Medicare's End-Stage Renal Disease Program.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.