title: Exploring the association between macroeconomic indicators and dialysis mortality.
abstract: OBJECTIVE
  Mortality on dialysis varies greatly worldwide, with patient-level factors explaining only a small part of this variation. The aim of this study was to examine the association of national-level macroeconomic indicators with the mortality of incident dialysis populations and explore potential explanations through renal service indicators, incidence of dialysis, and characteristics of the dialysis population.
  
  
  METHODS
  Aggregated unadjusted survival probabilities were obtained from 22 renal registries worldwide for patients starting dialysis in 2003-2005. General population age and health, macroeconomic indices, and renal service organization data were collected from secondary sources and questionnaires. Linear modeling with log-log transformation of the outcome variable was applied to establish factors associated with survival on dialysis.
  
  
  RESULTS
  Two-year survival on dialysis ranged from 62.3% in Iceland to 89.8% in Romania. A higher gross domestic product per capita (hazard ratio=1.02 per 1000 US dollar increase), a higher percentage of gross domestic product spent on healthcare (1.10 per percent increase), and a higher intrinsic mortality of the dialysis population (i.e., general population-derived mortality risk of the dialysis population in that country standardized for age and sex; hazard ratio=1.04 per death per 10,000 person years) were associated with a higher mortality of the dialysis population. The incidence of dialysis and renal service indicators were not associated with mortality on dialysis.
  
  
  CONCLUSIONS
  Macroeconomic factors and the intrinsic mortality of the dialysis population are associated with international differences in the mortality on dialysis. Renal service organizational factors and incidence of dialysis seem less important.
authors: European Renal Association-European Dialysis and TransplantationAssociation Registry, Academic Medical Center, University of Amsterdam, The Netherlands. a.kramer@amc.uva.nl
authors: Anneke
authors: A
authors: Kramer
authors: Vianda S
authors: VS
authors: Stel
authors: Fergus J
authors: FJ
authors: Caskey
authors: Benedicte
authors: B
authors: Stengel
authors: Robert F
authors: RF
authors: Elliott
authors: Adrian
authors: A
authors: Covic
authors: Claudia
authors: C
authors: Geue
authors: Ana
authors: A
authors: Cusumano
authors: Alison M
authors: AM
authors: Macleod
authors: Kitty J
authors: KJ
authors: Jager
mesh_terms: D000367:Age Factors; D000368:Aged; D005260:Female; D059066:Gross Domestic Product; D017048:Health Care Costs; D005102:Health Expenditures; D006302:Health Services Research; D006304:Health Status; D054625:Healthcare Disparities / Q000191:economics; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D011787:Quality of Health Care / Q000191:economics; D012042:Registries; D006435:Renal Dialysis / Q000191:economics* / Q000401:mortality*; D012111:Residence Characteristics; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome