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Association of insurance status with chronic kidney disease stage at diagnosis in children

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Abstract

Background

Whether medical insurance impacts the timely diagnosis in chronic kidney disease (CKD) children is unknown. We aim to examine the extent to which insurance is associated with access to timely diagnosis and different stages of CKD among a large population of children in China.

Methods

A retrospective, cross-sectional study based on China’s national hospitalized record database was carried out. Children aged 0–17 years diagnosed as CKD stages 1–5 between June 1, 2013, and December 31, 2018, were included. A diagnosis of advanced CKD stage (CKD stage 4 or 5) was the primary outcome. Multivariable logistic regression model adjusted for age, sex, cross-regional hospitalization, year of diagnosis, and cause of CKD was used to assess the association between insurance status and the stage of CKD when diagnosed.

Results

A total of 10,256 children (median [interquartile range, IQR] age, 12.4 [7.9, 15.4] years) were included. There were 4716 (46.0%) uninsured children in the included population. The insurance coverage was highest in children 13–17 years old (60.9%). The hospitalized charge was highest in stage 5 uninsured children (median [IQR], ¥13,000.89 [7640.63, 24,585.00]). More uninsured children are diagnosed in CKD stage 4 or 5 (48.1%) than insured children (47.5%). Uninsured children had higher odds (odds ratio [OR] 1.20, [95% CI, 1.08–1.32]) of receiving a diagnosis of CKD stage 4 or 5 compared with insured children.

Conclusions

Lack of medical insurance was associated with a more advanced stage of CKD when diagnosed in hospitalized children.

Graphical abstract

A higher resolution version of the Graphical abstract is available as Supplementary information.

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Data availability

The datasets generated during and analyzed during the current study are not publicly available due to the Hospital Quality Monitoring System (HQMS) database management rules. Still, they are available from the corresponding author on reasonable request. The SAS codes used to produce the results in this article are available from the corresponding author on request.

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Acknowledgements

The authors thank the Bureau of Medical Administration and Medical Service Supervision, NHC of the People’s Republic of China, all study participants, and the original data creators for forming the dataset. We thank Yangfeng Wu, M.D., Ph.D., Peking University Clinical Research Institute, for his helpful advice in revising the manuscript. We thank Ying Shi, B.M.S., and Lanxia Gan, B.S., China Standard Medical Information Research Center, Shenzhen, China, for their helpful advice in the analysis process.

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Authors and Affiliations

  1. Department of Pediatrics, Peking University First Hospital, No.1 Xi An Men Da Jie, Beijing, 100034, People’s Republic of China

    Guohua He & Jie Ding

  2. Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China

    Chenglong Li

  3. Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China

    Shengfeng Wang

  4. Clinical Trial Unit, The First Affiliated Hospital, Sun Yat-Sen University, No.58 Zhongshan 2nd Road, Guangzhou, 510080, People’s Republic of China

    Haibo Wang

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Contributions

G.H. contributed to the design, analysis of the data, and drafting of the article; C.L. performed the statistical analysis and drafting the article; S.W. contributed to the design and interpretation of the data; H.W. and J.D. are responsible for supervision for design, interpretation of the data, and revising the article. Each author contributed important intellectual content during this article drafting and revision and approved the final version of the article.

Corresponding authors

Correspondence to Haibo Wang or Jie Ding.

Ethics declarations

Ethics approval

This retrospective study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study protocol was reviewed and approved by the Ethics Committee Board of Peking University First Hospital (approval number: 2021 [009]).

Consent to participate

This research study was conducted retrospectively from data obtained for clinical and quality monitoring purposes. The use of this de-identified dataset in this study was approved by the Ethics Committee Board of Peking University First Hospital with a waiver of informed consent.

Consent for publication

This retrospective study used a de-identified dataset. Consent to publish from participants could not be applied in this study.

Conflict of interest

The authors declare no competing interests.

Research resource identifiers (RRID)

Software: SAS software 9.4 (SAS Inc., Cary, NC, USA), RRID: SCR_008567.

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Cite this article

He, G., Li, C., Wang, S. et al. Association of insurance status with chronic kidney disease stage at diagnosis in children. Pediatr Nephrol 37, 2705–2714 (2022). https://doi.org/10.1007/s00467-022-05493-6

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  • DOI: https://doi.org/10.1007/s00467-022-05493-6

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