title: Association between medical insurance type and survival in patients undergoing peritoneal dialysis.
abstract: BACKGROUND
  Socioeconomic characteristics may affect the outcomes of patients treated with peritoneal dialysis (PD). There are two major medical insurances in China: the New Cooperative Medical Scheme (NCMS), mainly for rural residents, and the Urban Employees' Medical Insurance (UEMI). The aim of the present study was to assess the effect of medical insurance type on survival of patient undergoing PD.
  
  
  METHODS
  This was a prospective study in adult patients who underwent PD at the Wuhan No.1 Hospital between January 2008 and December 2013. Patients had received continuous ambulatory PD for >3 months. Patients were divided according to their medical insurance. Demographic and socioeconomic data, biochemical parameters and primary clinical outcomes including all-cause mortality, switch to hemodialysis and kidney transplantation were analyzed.
  
  
  RESULTS
  There were 415 patients with UEMI and 149 with NCMS. Compared with UEMI, patients with NCMS were younger, and had shorter dialysis duration, smaller proportion of diabetic nephropathy, more severe anemia, and more frequent hyperphosphatemia and hyperuricemia. Total Kt/V, creatinine clearance and residual renal function were not different. There was no difference in technique survival (P > 0.05) between the two groups, but rural patients showed lower overall survival (P < 0.05). Multivariate analysis showed that NCMS was independently associated with lower survival (RR = 1.49; 95% CI = 1.04-2.15).
  
  
  CONCLUSIONS
  Medical insurance model is independently associated with PD patient survival.
authors.affiliation: Department of nephrology, Wuhan No.1 hospital, 430022, Wuhan, Hubei Province, China. wangzengsi@hotmail.com.
authors.forename: Zengsi
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of nephrology, Wuhan No.1 hospital, 430022, Wuhan, Hubei Province, China. hydzym@sina.com.
authors.forename: Yanmin
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of nephrology, Wuhan No.1 hospital, 430022, Wuhan, Hubei Province, China. xiongfeimedsci@126.com.
authors.forename: Fei
authors.initials: F
authors.lastname: Xiong
authors.affiliation: Department of nephrology, Wuhan No.1 hospital, 430022, Wuhan, Hubei Province, China. bobylhb@163.com.
authors.forename: Hongbo
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of nephrology, Wuhan No.1 hospital, 430022, Wuhan, Hubei Province, China. dingyanqiong888888@163.com.
authors.forename: Yanqiong
authors.initials: Y
authors.lastname: Ding
authors.affiliation: Department of nephrology, Wuhan No.1 hospital, 430022, Wuhan, Hubei Province, China. gaoyihua888888@163.com.
authors.forename: Yihua
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Department of nephrology, Wuhan No.1 hospital, 430022, Wuhan, Hubei Province, China. momo.cindy715@gmail.com.
authors.forename: Li
authors.initials: L
authors.lastname: Zhao
authors.affiliation: Department of nephrology, Wuhan No.1 hospital, 430022, Wuhan, Hubei Province, China. wansheng0214@163.com.
authors.forename: Sheng
authors.initials: S
authors.lastname: Wan
mesh_terms: D000328:Adult; D000368:Aged; D002681:China; D015331:Cohort Studies; D005260:Female; D006264:Health Benefit Plans, Employee / Q000191:economics; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D007348:Insurance, Health / Q000191:economics*; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010530:Peritoneal Dialysis / Q000191:economics / Q000379:methods; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000191:economics* / Q000379:methods; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011787:Quality of Health Care; D012424:Rural Population; D012959:Socioeconomic Factors; D016019:Survival Analysis; D014505:Urban Population