NDT Advance Access published online on July 15, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn406
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Incidence, prevalence and mortality trends of dialysis end-stage renal disease in Taiwan from 1990 to 2001: the impact of national health insurance
1 Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei 2 Division of Nephrology, Department of Medicine, Kaohsiung Medical University Hospital and Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
Correspondence and offprint requests to: Shang-Jyh Hwang, Division of Nephrology, Department of Medicine, Kaohsiung Medical University Hospital, 100 TzYou 1st Road, Sun-Ming District, Kaohsiung, 807, Taiwan. Tel: +886-7-3121101-7901; Fax: +886-7-3165706; E-mail: sjhwang{at}kmu.edu.tw
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Abstract |
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Background. Incident and prevalent (I&P) rates in dialysis end-stage renal disease (ESRD) patients in Taiwan increased rapidly following the launch of National Health Insurance (NHI) in 1995. Our aim was to explore the impact of NHI on the status and trends of ESRD epidemiology in Taiwan.
Methods. This study was conducted using retrospective cohort analysis of data collected from the Taiwan national dialysis registry.
Results. From 1990 to 2001, I&P rates of ESRD patients increased 2.6 times from 126 to 331 per million populations (pmp) and 3.46 times from 382 to 1322 pmp, respectively. Increasing ESRD was seen in patients who were middle-aged, elderly and who had diabetic nephropathy as their primary renal disease. The mean age of I&P patients increased by 7.2 years and 7.1 years, respectively. All of these parameters increased markedly in 1995, the year of NHI implementation. First-year mortality decreased to 7.8 per 1000 patient-months in 1994, and then increased to 18.0 in 2001. The cumulative survival rate of the elderly subgroup (age >65) in the incident 1990–1994 cohort was greater than in the 1995–1999 cohort. These data indicated that NHI implementation significantly influenced the inflow and the mortality of ESRD patients.
Conclusion. In addition to presenting ESRD epidemiology in Taiwan, this study demonstrated that NHI implementation stimulated the growth of treated ESRD populations. Preventive plans mounted against chronic kidney diseases will be essential to reduce the growth of ESRD patient numbers and consequent economic burdens.
Keywords: dialysis; health insurance; incidence; mortality; prevalence
* The authors Wu-Chang Yang and Shang-Jyh Hwang contributed equally to this paper as the first and corresponding authors.
Received for publication: 16. 1.08
Accepted in revised form: 26. 6.08