TY - JOUR
T1 - Effect of profit status in facilities on the mortality of patients on long-term haemodialysis
T2 - A nationwide cohort study
AU - Liu, Sheng Yu
AU - Cheng, Chung Yi
AU - Wu, Mei Yi
AU - Zheng, Cai Mei
AU - Hsu, Chih Cheng
AU - Wu, Mai Szu
AU - Lin, Yen Chung
N1 - Publisher Copyright:
© BMJ Publishing Group Limited 2021.
PY - 2021/9/2
Y1 - 2021/9/2
N2 - Objectives Over the past two decades, debates on whether the profit status of dialysis facilities influences patient prognosis have been popular in the USA. Taiwan is one of the regions with the highest rate per capita of kidney replacement therapy worldwide, but no similar research has been conducted to date. This is the first study to address this issue. Design This was a nationwide retrospective cohort study based on the Taiwan Renal Registry Data System. Setting Patients were categorised into two groups based on the profit status (for-profit, not-for-profit (NFP)) of dialysis facilities, with 31 350 patients in each group. The patients were followed up from 2005 to 2012. Participants Patients with uraemia who underwent long-term haemodialysis in private dialysis facilities and public facilities were excluded. Primary and secondary outcome measures Survival analyses were performed to compare prognosis between the two groups. Adjustments to patients' basic profile, and facilities' geographical distribution, level, and length of ownership were carried out to minimise possible confounding effects. Results Analysis revealed that NFP dialysis facilities had better outcomes (HR=0.91, 95% CI (0.89 to 0.93)). A favourable effect remains with the adjustment of the facilities' level, geographical distribution (HR=0.89, 95% CI (0.86 to 0.93)) or length of ownership (HR=0.95, 95% CI (0.89 to 0.95)). Survival analysis based on the geographical distribution and level of facilities was also conducted, which showed better prognosis in medical centres in the six municipalities, whereas worse prognosis was found in local hospitals not located in these municipalities. Conclusion Our findings suggest that in contemporary settings in Taiwan, treatment at NFP dialysis facilities was associated with a better prognosis. The results should be interpreted with caution since the possibility of residual confounding effects and uncertainty of casual relations exist due to the nature of observational studies.
AB - Objectives Over the past two decades, debates on whether the profit status of dialysis facilities influences patient prognosis have been popular in the USA. Taiwan is one of the regions with the highest rate per capita of kidney replacement therapy worldwide, but no similar research has been conducted to date. This is the first study to address this issue. Design This was a nationwide retrospective cohort study based on the Taiwan Renal Registry Data System. Setting Patients were categorised into two groups based on the profit status (for-profit, not-for-profit (NFP)) of dialysis facilities, with 31 350 patients in each group. The patients were followed up from 2005 to 2012. Participants Patients with uraemia who underwent long-term haemodialysis in private dialysis facilities and public facilities were excluded. Primary and secondary outcome measures Survival analyses were performed to compare prognosis between the two groups. Adjustments to patients' basic profile, and facilities' geographical distribution, level, and length of ownership were carried out to minimise possible confounding effects. Results Analysis revealed that NFP dialysis facilities had better outcomes (HR=0.91, 95% CI (0.89 to 0.93)). A favourable effect remains with the adjustment of the facilities' level, geographical distribution (HR=0.89, 95% CI (0.86 to 0.93)) or length of ownership (HR=0.95, 95% CI (0.89 to 0.95)). Survival analysis based on the geographical distribution and level of facilities was also conducted, which showed better prognosis in medical centres in the six municipalities, whereas worse prognosis was found in local hospitals not located in these municipalities. Conclusion Our findings suggest that in contemporary settings in Taiwan, treatment at NFP dialysis facilities was associated with a better prognosis. The results should be interpreted with caution since the possibility of residual confounding effects and uncertainty of casual relations exist due to the nature of observational studies.
KW - chronic renal failure
KW - dialysis
KW - end stage renal failure
KW - health economics
UR - http://www.scopus.com/inward/record.url?scp=85114493593&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2020-045832
DO - 10.1136/bmjopen-2020-045832
M3 - 文章
C2 - 34475147
AN - SCOPUS:85114493593
SN - 2044-6055
VL - 11
JO - BMJ Open
JF - BMJ Open
IS - 9
M1 - e045832
ER -