title: Maps of systematic variation in renal replacement therapy in Catalonia (2002-2012).
abstract: BACKGROUND
  Variations in the use of healthcare services can be defined as systematic variations of adjusted rates for certain aggregation levels of the population. The study analyses how renal replacement therapy (RRT) is used, identifying RRT variability in Catalonia from 2002 to 2012.
  
  
  METHODS
  Ecological study by health area using data from the Catalan renal registry. We present incident rates, standardised incidence ratios and prevalence, while variability was calculated through direct and indirect standardisation methods.
  
  
  RESULTS
  From 2002 until 31/12/2012, 10,784 patients initiated RRT in Catalonia: 9,238 on haemodialysis (HD) (50 treatments per 100,000 people 2010/2012), 1,076 on peritoneal dialysis (PD) (8.2 treatments per 100,000 people 2010/2012) and 470 received an early kidney transplant (KT) (4.4 treatments per 100,000 people 2010/2012). Over the 10 years, the HD cumulative incidence rate fell (7%), while the PD and KT incidence rates increased (63% and 177%, respectively); both are higher in young patients (<45 years). 4,750 patients received a kidney transplant in this period, 49% of which were aged between 45 and 65 years. There were no significant differences in variability in HD (RV5-95=1.3; Empirical Bayes [EB]∼ 0), or in the prevalence of KT (RV5-95=1.4; EB ∼ 0). Nevertheless, we found significant geographical variability in PD; notably in the districts of the province of Lérida, where the number of cases observed was greater than expected (RV5-95=4.01; EB=0.08).
  
  
  CONCLUSIONS
  Although there was a notable rise in PD and early KT incidence rates, PD is still underused when compared to international recommendations. No territorial variability was found for HD or KT, but the use of PD was found to be higher in Lérida than in other areas. To reduce PD territorial variability and increase the uptake of this technique in the other regions, we propose 3initiatives: The development of RRT support tools for shared decision-making, the encouragement of specific PD professional training and the promotion of PD through complementary reimbursement systems.
authors.affiliation: Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS); Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC); Universitat Rovira i Virgili (URV), Barcelona, España.
authors.forename: Cristian
authors.initials: C
authors.lastname: Tebé Condomí
authors.affiliation: Organització Catalana de Trasplantaments (OCATT), Barcelona, España.
authors.forename: Emma
authors.initials: E
authors.lastname: Arcos
authors.affiliation: Organització Catalana de Trasplantaments (OCATT), Barcelona, España.
authors.forename: Jordi
authors.initials: J
authors.lastname: Comas
authors.affiliation: Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS); Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC); Universitat Rovira i Virgili (URV), Barcelona, España.
authors.forename: Mireia
authors.initials: M
authors.lastname: Espallargues
authors.affiliation: Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS); CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, España.
authors.forename: Joan M V
authors.initials: JMV
authors.lastname: Pons
authors.affiliation: Fundació Puigvert, Barcelona, España.
authors.forename: Joan M
authors.initials: JM
authors.lastname: Díaz
authors.affiliation: Organització Catalana de Trasplantaments (OCATT), Barcelona, España.
authors.forename: Jaume
authors.initials: J
authors.lastname: Tort
authors.affiliation: Hospital Universitari de Bellvitge, Hospitalet (Barcelona), España; REDinREN, Instituto de Salud Carlos III, IDIBELL, Madrid. Electronic address: amartinez@bellvitgehospital.cat.
authors.forename: Alberto
authors.initials: A
authors.lastname: Martinez-Castelao
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data*; D013030:Spain; D013997:Time Factors
keywords: Atlas; Diálisis peritoneal; Estandarización; Haemodialysis; Hemodiálisis; Kidney transplant; Peritoneal dialysis; Registro; Registry; Renal replacement therapy; Small areas; Standardisation; Trasplante renal; Tratamiento sustitutivo renal; Variaciones; Variations; Áreas pequeñas