Abstract
Purpose
Brazil has one of the world’s highest numbers of patients on hemodialysis (HD). Most dialysis centers are private and perform HD for patients with private and public health insurance. We compared 1-year survival between patients initiating chronic HD with public and private health insurance.
Methods
This is an HD register-based retrospective cohort. Adult patients starting HD from January 2011 to December 2021 were included. Survival analysis was stratified according to the period entered in the HD register. Multivariate Cox regression focused on 1-year survival differences between private and public patients.
Results
In the final sample (n = 5114), 68.5% of participants had public and 31.3% to private health insurance, with overall 1-year survival of 92.8% and 89.9%, respectively (p = 0.002). Crude analysis showed a slightly higher survival rate among patients with public health insurance than those with private health insurance (91 vs. 87%, p = 0.030) in the first period (2019–21). However, the adjusted hazard ratio (HR) did not remain significantly higher for patients with private health insurance compared to those with public health insurance (HR = 1.07; 95% CI 0.80–1.41; p = 0.651), even after propensity score matching of the groups by several baseline features.
Conclusion
Brazilian chronic HD patients funded by either private health plans or the public system have a similar 1-year mortality risk after controlling for several sociodemographic and clinical parameters.
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Acknowledgements
We want to thank all the support received by the Brazilian Society of Nephrology and from the Researchers of the Brazilian Registry of Dialysis mentioned below: Roberto Benvenutti; Márcio A. Moraes; Natasha S. Constancio; Ian R. Rehfeldt; Fabia Fernandez; Rodrigo Braz; Neyde V. Pontes; Gelzie S. Ennes; Marcos A. Mura; Rosilene Coelho; Jair B. Miguel; Márcia B. Hexsel Abichequer; Silvia C. Medeiros; Gelson A. dos Santos; João C. Biernat; Orlando B. Junior; Eli N. da Silva; Nilsa R. Martins; Patrícia S. Teixeira; Luciana F. Serpa; Cristina L. Pinto; Antonio A. C. de Brito; Luiz C. A.Gonçalves; Rosa Malta; Sinaria A. Ojeda; Jorge A.V. de Menezes; Maria P. de Souza; Tania D.Sobral; Ismar C. M. Junior; Cristiano V. da Silva; Gisele F. Furtado; Silvana M. Oliveira; Luiz F. B. de Figueiredo; Maria E. D. Diniz; Sérgio G.E. Bucharles; João D. S. Simões; Geraldo A. Córdova; Renata L. Starling; Sandra T. S.N. Coelho; Mendell D.Lemos; Maria F. Alvarenga; Ana L.Cabeça; Beatriz Veneza; José M. V. Obregón; Fernanda S. G. Polacchini; Hotone Dallacosta; Marcelo F. Ruas; Yoshimi Watanabe; André L. Marassi; Leandro J. Lucca; Cyro N. F. M. Filho; Wagner S. Catharina; Fernando S. Thomé; Milene C.D. Guilhem; Jeronimo R. Centeno; Flavio M. de Paula; Marcos Gevert; Marco Túlio; Renato J. P. de Medeiros; Manif C, Jorge; Nelson José; Consuelo V. de Carvalho; Ana B. B. Palazzo; Carlos E. Comin; Marcelo A. Gonçalves; Maziael Moraes; Henrique L. Carrascossi; Januário G. Roberto; Roberto E. Salon; Marilia B. Oliveira; Flávio J. D. de Moura; Helio E. Galvão; Ana C. V. do Amaral Barbosa; Zita M. Leme; Raimundo M. Neto; Mario E. Rodrigues; Elzo R. Junior; Maria G. Polito; Tânia Brandão; Angela Barros; Glória M. F. dos Reis; João C. Filho; Aparecida P.G. Visoná; Nilso Moreira; Rodrigo M. Pereira; Ricardo A. Mothé; Homero N. C e .A. Sul; Fernando F. Neto; Jadny J. Dornelas; Ciro T. Costa; Jorge L. Z. Ramos.
Funding
This study has been done without funding or support grants, just with support funding for publication by the Brazilian Society of Nephrology. RS receives a research grant from the Brazilian Research Council (CNPq).
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do Nascimento Lima, H., Monárrez-Espino, J., Nerbass, F.B. et al. Comparison of 1-year survival between patients initiating chronic hemodialysis under public and private health insurance: register-based data analysis from Brazil. Int Urol Nephrol (2024). https://doi.org/10.1007/s11255-024-04018-4
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DOI: https://doi.org/10.1007/s11255-024-04018-4