title: Regional variations in the incidence of end-stage renal failure in Japan.
abstract: BACKGROUND
  Despite recent medical advances, the number of patients beginning dialysis annually is increasing in both the United States and Japan. The ethnically homogeneous population of Japan presents an opportunity to study the presence of factors other than race/ethnicity that might contribute to incidence of end-stage renal disease (ESRD).
  
  
  OBJECTIVE
  To determine if and where regional differences exist in ESRD in Japan.
  
  
  METHODS
  Analysis of data reported by the Japanese Society for Dialysis Therapy based on the annual number of patients with ESRD beginning maintenance dialysis therapy in all 47 prefectures of Japan from 1982 to 1998.
  
  
  METHODS
  Mean annual ESRD incidence and increasing rate of ESRD in each of 11 predefined areas making up the entire country.
  
  
  RESULTS
  Incidence of ESRD increased approximately 3-fold in Japan during the study years, from 81.3 per 1 million in 1982 to 237.6 per 1 million in 1998. Significant regional differences were found in both measures. The mean (SEM) annual ESRD incidence (P<.01) and increasing rate of ESRD (P<.01), respectively, were significantly different across Japan. Koshinetsu (140 [11] per 1 million and 9.1 [0.6] per 1 million/y) and Hokuriku (141 [12] per 1 million and 9.7 [0.5] per 1 million/y) were the areas with the lowest incidence and increasing rate of incidence, while Okinawa (188 [17] per 1 million and 13.4 [0.6] per 1 million/y) and Kyushu (179 [15] per 1 million and 12.0 [0.6] per 1 million/y) were the areas with the highest incidence and increasing rate of incidence.
  
  
  CONCLUSIONS
  We found definite and significant regional differences in incidence and increasing rate of incidence of ESRD in Japan. Further analyses are needed to identify factors that contribute to these regional differences and thereby improve strategies for treatment of renal disease. JAMA. 2000;284:2622-2624.
authors.affiliation: Department of Internal Medicine and Pathophysiology, Nagoya City University Medical School, Mizuho-ku, Nagoya 467-8601 Japan. t-usami@med.nagoya-cu.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Usami
authors.forename: K
authors.initials: K
authors.lastname: Koyama
authors.forename: O
authors.initials: O
authors.lastname: Takeuchi
authors.forename: K
authors.initials: K
authors.lastname: Morozumi
authors.forename: G
authors.initials: G
authors.lastname: Kimura
mesh_terms: D000704:Analysis of Variance; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012307:Risk Factors