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Mapping end-stage renal disease (ESRD): spatial variations on small area level in northern France, and association with deprivation.

Occelli F, Deram A, Génin M, Noël C, Cuny D, Glowacki F, Néphronor Netwo - PLoS ONE (2014)

Bottom Line: In France, at the district level, the highest incidence rates have been found in the Nord-Pas-de-Calais region.Although no correlation is found with diabetic or vascular nephropathy, the smoothed SIRs are correlated with the Townsend index (RR: 1.18, 95% CI [1.00-1.34] for Q2; 1.28, 95% CI [1.11-1.47] for Q3; 1.30, 95% CI [1.14-1.51] for Q4; 1.44, 95% CI [1.32-1.74] for Q5).This association is probably independent of the patients' financial ability to gain access to healthcare.

View Article: PubMed Central - PubMed

Affiliation: EA 4483, Université Lille Nord de France, Faculté de Pharmacie de Lille, Lille, France.

ABSTRACT

Background: Strong geographic variations in the incidence of end-stage renal disease (ESRD) are observed in developed countries. The reasons for these variations are unknown. They may reflect regional inequalities in the population's sociodemographic characteristics, related diseases, or medical practice patterns. In France, at the district level, the highest incidence rates have been found in the Nord-Pas-de-Calais region. This area, with a high population density and homogeneous healthcare provision, represents a geographic situation which is quite suitable for the study, over small areas, of spatial disparities in the incidence of ESRD, together with their correlation with a deprivation index and other risk factors.

Methods: The Renal Epidemiology and Information Network is a national registry, which lists all ESRD patients in France. All cases included in the Nord-Pas-de-Calais registry between 2005 and 2011 were extracted. Adjusted and smoothed standardized incidence ratio (SIR) was calculated for each of the 170 cantons, thanks to a hierarchical Bayesian model. The correlation between ESRD incidence and deprivation was assessed using the quintiles of Townsend index. Relative risk (RR) and credible intervals (CI) were estimated for each quintile.

Results: Significant spatial disparities in ESRD incidence were found within the Nord-Pas-de-Calais region. The sex- and age-adjusted, smoothed SIRs varied from 0.66 to 1.64. Although no correlation is found with diabetic or vascular nephropathy, the smoothed SIRs are correlated with the Townsend index (RR: 1.18, 95% CI [1.00-1.34] for Q2; 1.28, 95% CI [1.11-1.47] for Q3; 1.30, 95% CI [1.14-1.51] for Q4; 1.44, 95% CI [1.32-1.74] for Q5).

Conclusion: For the first time at this aggregation level in France, this study reveals significant geographic differences in ESRD incidence. Unlike the time of renal replacement care, deprivation is certainly a determinant in this phenomenon. This association is probably independent of the patients' financial ability to gain access to healthcare.

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Spatial distribution of Townsend deprivation index by cantons, 2009.
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pone-0110132-g003: Spatial distribution of Townsend deprivation index by cantons, 2009.

Mentions: The Townsend deprivation index varies strongly within the region (Table 1, Fig. 3), and there is a significant correlation between smoothed SIRs and the Townsend index quintiles. With Q1 taken as a reference, the relative risk (RR) of RRT was assessed for each level of deprivation (Fig. 4). Higher levels of deprivation are associated with an increase in RR: 1.18, 95% CI [1.00–1.34] for Q2, 1.28, 95% CI [1.11–1.47] for Q3, 1.30, 95% CI [1.14–1.51] for Q4 and 1.44, 95% CI [1.32–1.74] for Q5. In addition, the residential Townsend index attributed to each collected case was compared with late referral, estimated by means of the number of visits to a nephrologist in the year preceding treatment. No correlation is found (p = 0.66).


Mapping end-stage renal disease (ESRD): spatial variations on small area level in northern France, and association with deprivation.

Occelli F, Deram A, Génin M, Noël C, Cuny D, Glowacki F, Néphronor Netwo - PLoS ONE (2014)

Spatial distribution of Townsend deprivation index by cantons, 2009.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4217729&req=5

pone-0110132-g003: Spatial distribution of Townsend deprivation index by cantons, 2009.
Mentions: The Townsend deprivation index varies strongly within the region (Table 1, Fig. 3), and there is a significant correlation between smoothed SIRs and the Townsend index quintiles. With Q1 taken as a reference, the relative risk (RR) of RRT was assessed for each level of deprivation (Fig. 4). Higher levels of deprivation are associated with an increase in RR: 1.18, 95% CI [1.00–1.34] for Q2, 1.28, 95% CI [1.11–1.47] for Q3, 1.30, 95% CI [1.14–1.51] for Q4 and 1.44, 95% CI [1.32–1.74] for Q5. In addition, the residential Townsend index attributed to each collected case was compared with late referral, estimated by means of the number of visits to a nephrologist in the year preceding treatment. No correlation is found (p = 0.66).

Bottom Line: In France, at the district level, the highest incidence rates have been found in the Nord-Pas-de-Calais region.Although no correlation is found with diabetic or vascular nephropathy, the smoothed SIRs are correlated with the Townsend index (RR: 1.18, 95% CI [1.00-1.34] for Q2; 1.28, 95% CI [1.11-1.47] for Q3; 1.30, 95% CI [1.14-1.51] for Q4; 1.44, 95% CI [1.32-1.74] for Q5).This association is probably independent of the patients' financial ability to gain access to healthcare.

View Article: PubMed Central - PubMed

Affiliation: EA 4483, Université Lille Nord de France, Faculté de Pharmacie de Lille, Lille, France.

ABSTRACT

Background: Strong geographic variations in the incidence of end-stage renal disease (ESRD) are observed in developed countries. The reasons for these variations are unknown. They may reflect regional inequalities in the population's sociodemographic characteristics, related diseases, or medical practice patterns. In France, at the district level, the highest incidence rates have been found in the Nord-Pas-de-Calais region. This area, with a high population density and homogeneous healthcare provision, represents a geographic situation which is quite suitable for the study, over small areas, of spatial disparities in the incidence of ESRD, together with their correlation with a deprivation index and other risk factors.

Methods: The Renal Epidemiology and Information Network is a national registry, which lists all ESRD patients in France. All cases included in the Nord-Pas-de-Calais registry between 2005 and 2011 were extracted. Adjusted and smoothed standardized incidence ratio (SIR) was calculated for each of the 170 cantons, thanks to a hierarchical Bayesian model. The correlation between ESRD incidence and deprivation was assessed using the quintiles of Townsend index. Relative risk (RR) and credible intervals (CI) were estimated for each quintile.

Results: Significant spatial disparities in ESRD incidence were found within the Nord-Pas-de-Calais region. The sex- and age-adjusted, smoothed SIRs varied from 0.66 to 1.64. Although no correlation is found with diabetic or vascular nephropathy, the smoothed SIRs are correlated with the Townsend index (RR: 1.18, 95% CI [1.00-1.34] for Q2; 1.28, 95% CI [1.11-1.47] for Q3; 1.30, 95% CI [1.14-1.51] for Q4; 1.44, 95% CI [1.32-1.74] for Q5).

Conclusion: For the first time at this aggregation level in France, this study reveals significant geographic differences in ESRD incidence. Unlike the time of renal replacement care, deprivation is certainly a determinant in this phenomenon. This association is probably independent of the patients' financial ability to gain access to healthcare.

Show MeSH
Related in: MedlinePlus