title: The delivery of renal replacement therapy in Scotland--why the geographic variation?
abstract: BACKGROUND
  The incidence of patients starting renal replacement therapy (RRT) for established renal failure (ERF) in Scotland has fallen from 2005 to 2011 due to a reduction in older patients starting RRT; there are significant differences between NHS Health board areas.
  
  
  OBJECTIVE
  To understand the apparent inequality in provision of RRT between NHS board areas in Scotland.
  
  
  METHODS
  Retrospective population analysis of Scottish renal registry (SRR) data, population statistics and quality outcomes framework summary statistics.
  
  
  RESULTS
  The incidence of patients starting RRT for ERF in Scotland fell from 123 per million population (pmp) in 2005 to 96 pmp in 2011. The incidence of ≥75 year olds fell from 406 to 274 pmp. There are significant differences between NHS board areas when standardized for age and social deprivation. There is no relationship between the population prevalence of CKD as reported by QOF and the incidence of RRT for ERF. Those areas with high incidence rates of ≥75 year olds have higher 90-day [Spearman's rank correlation: coefficient = 0.662; P = 0.03] and 1-year [Spearman's rank correlation: coefficient = 0.776; P = 0.003] mortality rates.
  
  
  CONCLUSIONS
  The significant variation in provision of RRT for ERF between Scottish NHS Board areas is not explained by age or social deprivation. There is evidence of change in practice towards RRT for patients aged ≥75 years but variation between NHS Board areas. This disparity must be further investigated to ensure equity of access to RRT for those who will benefit from it, and to non-dialytic care for those who would not.
authors: Renal Unit, Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, UK. wendy.metcalfe@nhs.net.
authors: J
authors: J
authors: Boyd
authors: M W B
authors: MW
authors: Mackinnon
authors: A
authors: A
authors: Severn
authors: J P
authors: JP
authors: Traynor
authors: C E
authors: CE
authors: Whitworth
authors: W
authors: W
authors: Metcalfe
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D003695:Delivery of Health Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006302:Health Services Research / Q000379:methods; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012042:Registries; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data* / Q000639:trends; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology; D012959:Socioeconomic Factors; D013222:State Medicine / Q000706:statistics & numerical data; D016019:Survival Analysis; D055815:Young Adult