The effects of individual and neighborhood socioeconomic status on early nephrology referral for hemodialysis patients

Chia Tien Chang, Shiao Chi Wu, Yen Ni Hung, Yee Yung Ng, Hui Shan Chen

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objectives: Tackling health inequalities is a key concern of public health policy makers. The major purpose of Taiwan's National Health Insurance (NHI) is to reduce the financial barriers to care. It is worth ascertaining if individual and neighborhood socioeconomic inequalities exist in early nephrology referral for hemodialysis patients. Methods: This population-based retrospective cohort study examined the incidence of new hemodialysis patients in 2009 as identified from the Taiwan National Health Insurance database and relevant secondary data. Early referral was defined as patients meeting with a nephrologist more than 90 days before initial hemodialysis. Stepwise binomial logistic regression models were performed to examine the effect of individual socioeconomic status (SES) (premium-based monthly salary (NT$), level of education, and employment status) and neighborhood SES ("average family income and expenditure per household" and "educational attainment of the population aged 15 and over - junior college and above") on early nephrology referral after controlling for demographic characteristics, co-morbid conditions, and characteristics of major health care organizations before referral. Results: A total of 7,687 consecutive adult incident hemodialysis patients were identified, and 70.9% of them were referred early. Unemployed patients and those with a lower premium-based monthly salary had significantly lower early referral rates after controlling for other factors (OR=0.81, 95%CI=0.70-0.93; OR=0.84, 95%CI=0.73-0.95). No significant associations were found between neighborhood SES and referral pattern. Conclusions: Individual socioeconomic inequalities exist in early nephrology referral for hemodialysis patients despite universal health coverage. The causes of this finding require further investigation.

Original languageEnglish
Pages (from-to)75-88
Number of pages14
JournalTaiwan Journal of Public Health
Volume33
Issue number1
DOIs
Publication statusPublished - 2014

Fingerprint

Nephrology
Social Class
Renal Dialysis
Referral and Consultation
Salaries and Fringe Benefits
National Health Programs
Taiwan
Logistic Models
Universal Coverage
Health
Public Policy
Health Expenditures
Health Policy
Administrative Personnel
Population
Cohort Studies
Retrospective Studies
Public Health
Demography
Organizations

Keywords

  • Early nephrology referral
  • Hemodialysis
  • Socioeconomic status

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

The effects of individual and neighborhood socioeconomic status on early nephrology referral for hemodialysis patients. / Chang, Chia Tien; Wu, Shiao Chi; Hung, Yen Ni; Ng, Yee Yung; Chen, Hui Shan.

In: Taiwan Journal of Public Health, Vol. 33, No. 1, 2014, p. 75-88.

Research output: Contribution to journalArticle

Chang, Chia Tien ; Wu, Shiao Chi ; Hung, Yen Ni ; Ng, Yee Yung ; Chen, Hui Shan. / The effects of individual and neighborhood socioeconomic status on early nephrology referral for hemodialysis patients. In: Taiwan Journal of Public Health. 2014 ; Vol. 33, No. 1. pp. 75-88.
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