title: Addressing health disparities in chronic kidney disease.
abstract: According to the official health statistics, Taiwan has the highest prevalence of end stage renal disease (ESRD) in the world. Each year, around 60,000 ESRD patients in Taiwan consume 6% of the national insurance budget for dialysis treatment. The prevalence of chronic kidney disease (CKD) has been climbing during 2008-2012. However, the spatial disparities and clustering of CKD at the public health level have rarely been discussed. The aims of this study are to explore the possible population level risk factors and identify any clusters of CKD, using the national health insurance database. The results show that the ESRD prevalence in females is higher than that in males. ESRD medical expenditure constitutes 87% of total CKD medical expenditure. Pre-CKD and pre-ESRD disease management might slow the progression from CKD to ESRD. After applying ordinary least-squares regression, the percentages of high education status and the elderly in the townships are positively correlated with CKD prevalence. Geographically weighted regression and Local Moran's I are used for identifying the clusters in southern Taiwan. The findings can be important evidence for earlier and targeted community interventions and reducing the health disparities of CKD.
authors.affiliation: Research Center for Humanities and Social Sciences, Academia Sinica, Taipei City 115, Taiwan. dachianpig@gmail.com.
authors.forename: Ta-Chien
authors.initials: TC
authors.lastname: Chan
authors.affiliation: Research Center for Humanities and Social Sciences, Academia Sinica, Taipei City 115, Taiwan. mhfanbbc@ccvax.sinica.edu.tw.
authors.forename: I-Chun
authors.initials: IC
authors.lastname: Fan
authors.affiliation: Research Center for Humanities and Social Sciences, Academia Sinica, Taipei City 115, Taiwan. liumike@gate.sinica.edu.tw.
authors.forename: Michael Shi-Yung
authors.initials: MS
authors.lastname: Liu
authors.affiliation: Department of Bioenvironmental Systems Engineering, National Taiwan University, Taipei City 106, Taiwan. sumd@ntu.edu.tw.
authors.forename: Ming-Daw
authors.initials: MD
authors.lastname: Su
authors.affiliation: Institute of Population Health Sciences, National Health Research Institutes, Miaoli County 350, Taiwan. chiangp@nhri.org.tw.
authors.forename: Po-Huang
authors.initials: PH
authors.lastname: Chiang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016000:Cluster Analysis; D005260:Female; D005843:Geography; D054624:Health Status Disparities; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult