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

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  • Cindy M. Padilla

    (Univ Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins) – EA 7449, F-35000 Rennes, France)

  • Maxime Raffray

    (Univ Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins) – EA 7449, F-35000 Rennes, France)

  • Adélaïde Pladys

    (Univ Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins) – EA 7449, F-35000 Rennes, France)

  • Cécile Vigneau

    (CHU Pontchaillou, Service de Néphrologie, 35033 Rennes, France
    Univ Rennes, EHESP, Inserm, Irset (Institut de recherche en santé, environnement et travail) – UMR_S 1085, F-35000 Rennes, France)

  • Sahar Bayat

    (Univ Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins) – EA 7449, F-35000 Rennes, France)

Abstract

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.

Suggested Citation

  • Cindy M. Padilla & Maxime Raffray & Adélaïde Pladys & Cécile Vigneau & Sahar Bayat, 2018. "Geographic Variations in the Risk of Emergency First Dialysis for Patients with End Stage Renal Disease in the Bretagne Region, France," IJERPH, MDPI, vol. 16(1), pages 1-16, December.
    • Handle: RePEc:gam:jijerp:v:16:y:2018:i:1:p:18-:d:192356
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    1. Perchoux, Camille & Kestens, Yan & Thomas, Frédérique & Hulst, Andraea Van & Thierry, Benoit & Chaix, Basile, 2014. "Assessing patterns of spatial behavior in health studies: Their socio-demographic determinants and associations with transportation modes (the RECORD Cohort Study)," Social Science & Medicine, Elsevier, vol. 119(C), pages 64-73.
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    1. Maxime Raffray & Sahar Bayat & Arnaud Campéon & Laëtitia Laude & Cécile Vigneau, 2019. "The Pre-Dialysis Care Trajectory of Chronic Kidney Disease Patients and the Start of Dialysis in Emergency: A Mixed Method Study Protocol," IJERPH, MDPI, vol. 16(24), pages 1-11, December.

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