Geographic Variations in the Risk of Emergency First Dialysis for Patients with End Stage Renal Disease in the Bretagne Region, France

Cindy Padilla (1, 2) , Maxime Raffray (1, 2) , Adélaide Pladys (1, 2) , Cécile Vigneau (3, 4) , Sahar Bayat (1, 2)

1 REPERES - Recherche en Pharmaco-épidémiologie et Recours aux Soins
2 EHESP - École des Hautes Études en Santé Publique [EHESP]
3 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
4 Irset - Institut de recherche en santé, environnement et travail

Emergency first dialysis start considerably increases the risk of morbidity and mortality. Our objective was to identify the geographic variations of emergency first dialysis risk in patients with end-stage renal disease in the Bretagne region, France. The spatial scan statistic approach was used to determine the clusters of municipalities with significantly higher or lower risk of emergency first dialysis. Patient data extracted from the REIN registry (sociodemographic, clinical, and biological characteristics) and indicators constructed at the municipality level, were compared between clusters. This analysis identified a cluster of municipalities in western Bretagne with a significantly higher risk (RR = 1.80, p = 0.044) and one cluster in the eastern part of the region with a significantly lower risk (RR = 0.59, p < 0.01) of emergency first dialysis. The degree of urbanization (the proportion of rural municipalities: 76% versus 66%, p < 0.001) and socio-demographic characteristics (the unemployment rate: 11% versus 8%, p < 0.001, the percentage of managers in the labor force was lower: 9% versus 13% p < 0.001) of the municipalities located in the higher-risk cluster compared with the lower-risk cluster. Our analysis indicates that the patients’ clinical status cannot explain the geographic variations of emergency first dialysis incidence in Bretagne. Conversely, where patients live seems to play an important role.

Mots clés: Emergency first dialysis; Socio-demographic; End stage renal disease; Patient and municipality level; Spatial analysis

Domaines: Santé publique et épidémiologie; Santé; Urologie et Néphrologie; Sciences du Vivant [q-bio]

Cindy Padilla, Maxime Raffray, Adélaide Pladys, Cécile Vigneau, Sahar Bayat. Geographic Variations in the Risk of Emergency First Dialysis for Patients with End Stage Renal Disease in the Bretagne Region, France. International Journal of Environmental Research and Public Health, 2019, 16 (1), pp.18. ⟨10.3390/ijerph16010018⟩. ⟨hal-01978721⟩