title: Impact of individual and environmental socioeconomic status on peritoneal dialysis outcomes: a retrospective multicenter cohort study.
abstract: OBJECTIVE
  We aimed to explore the impacts of individual and environmental socioeconomic status (SES) on the outcome of peritoneal dialysis (PD) in regions with significant SES disparity, through a retrospective multicenter cohort in China.
  
  
  METHODS
  Overall, 2,171 incident patients from seven PD centers were included. Individual SES was evaluated from yearly household income per person and education level. Environmental SES was represented by regional gross domestic product (GDP) per capita and medical resources. Undeveloped regions were defined as those with regional GDP lower than the median. All-cause and cardiovascular death and initial peritonitis were recorded as outcome events.
  
  
  RESULTS
  Poorer PD patients or those who lived in undeveloped areas were younger and less-educated and bore a heavier burden of medical expenses. They had lower hemoglobin and serum albumin at baseline. Low income independently predicted the highest risks for all-cause or cardiovascular death and initial peritonitis compared with medium and high income. The interaction effect between individual education and regional GDP was determined. In undeveloped regions, patients with an elementary school education or lower were at significantly higher risk for all-cause death but not cardiovascular death or initial peritonitis compared with those who attended high school or had a higher diploma. Regional GDP was not associated with any outcome events.
  
  
  CONCLUSIONS
  Low personal income independently influenced all-cause and cardiovascular death, and initial peritonitis in PD patients. Education level predicted all-cause death only for patients in undeveloped regions. For PD patients in these high risk situations, integrated care before dialysis and well-constructed PD training programs might be helpful.
authors.affiliation: Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health, Key Laboratory of Renal Disease, Ministry of Education, Beijing, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Xu
authors.forename: Qing-Feng
authors.initials: QF
authors.lastname: Han
authors.forename: Tong-Ying
authors.initials: TY
authors.lastname: Zhu
authors.forename: Ye-Ping
authors.initials: YP
authors.lastname: Ren
authors.forename: Jiang-Hua
authors.initials: JH
authors.lastname: Chen
authors.forename: Hui-Ping
authors.initials: HP
authors.lastname: Zhao
authors.forename: Meng-Hua
authors.initials: MH
authors.lastname: Chen
authors.forename: Jie
authors.initials: J
authors.lastname: Dong
authors.forename: Yue
authors.initials: Y
authors.lastname: Wang
authors.forename: Chuan-Ming
authors.initials: CM
authors.lastname: Hao
authors.forename: Rui
authors.initials: R
authors.lastname: Zhang
authors.forename: Xiao-Hui
authors.initials: XH
authors.lastname: Zhang
authors.forename: Mei
authors.initials: M
authors.lastname: Wang
authors.forename: Na
authors.initials: N
authors.lastname: Tian
authors.forename: Hai-Yan
authors.initials: HY
authors.lastname: Wang
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003906:Developing Countries / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006291:Health Policy; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D018579:Patient Selection; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012923:Social Class; D016896:Treatment Outcome