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Incidence & Prevalence of ESRD
ONE Incidence &d Prevalence o f
ESRD
The absence of romance in my history will, I fear, detract somewhat from its interest; but I shall be content if it is judged useful by those inquirers who desire an exact knowledge of the past as an aid to the interpretation of the future, which in the course of human things must resemble if it does not reflect it. Thucydides, Peloponnesian War
American Journal of Kidney Diseases, Vol 36, No 6, Suppl 2 (December), 2000: pp S37-S54
S38 · 2000
ATLAS
OF
ESRD
IN
THE
UNITED
STATES
The ESRD population in the United States and
Americans have the highest rate of diabetes, but
its territories continues to increase. Incident
the lowest rate of hypertension/large vessel dis
counts are projected to rise to 172,667 by 2010,
ease. Rates of diabetes are also high among His
while 1998 prevalent counts—influenced by in
panic patients. The highest rate of glomerulone-
creased rates of disease, better dialysis therapy and
phritis is seen in Asian patients, in whom the
anemia control, improved graft survival, and
disease is twice as frequent as in black patients
lower death rates—are projected to rise approxi
(table 1.7). These differences tend to dissipate in
mately 77% to exceed 660,000 in 2010 (fig 1.3).
the transplant population, though glomerulonephritis is seen in almost a quarter of Native Ameri
Racial differences are evident across modalities
can and Hispanic transplant patients.
in both incident and prevalent populations (tables 1.1-6). Between 1994 and 1998 the greatest per
It is unclear why the rate of diabetes continues to
centage increases in the number of hemodialysis
increase—even when adjusted for age, gender,
patients have been in the Native American and
and race—while rates of non-diabetic incidence
Asian populations. The number of prevalent pa
remain steady (table p. 1). While low protein di
tients per million population, however, is high
ets, blood pressure control, and ACE inhibitors
est for black and Native American patients—
have all been available for some time, they do not
All data underlying the compared to that of white patients, the rate is appear to have influenced the diabetic popula almost five times higher for black hemodialysis
tion. The dramatic rise in diabetes in the inci
figures in this chapter, patients, and three times higher for Native Ameri dent dialysis population maybe related to the ad cans on the same modality. While the number of
vancing obesity, carbohydrate intolerance, and
as well as additional related prevalent black transplant patients has increasedinsulin resistance suggested by recent trends of 9% since 1994, second only to the increase in the data, may be viewed &
who are transplanted at the beginning of ESRD downloaded at
increased weight and body mass index at initia
Asian population, the number of black patientstion of therapy (fig 1.14). Early clinical trials do suggest that, while glycemic control does not stop
therapy has decreased 22%, suggesting that black or reverse the course of advancing renal failure, it patients are increasingly likely to begin ESRD
can slow the disease by 30-50%. It may be that
www. usrds. org. treatment with dialysis instead of transplantation. more aggressive glycemic control and treatment of lipid disorders are needed to lower the diabetic Gender differences are
incident rate.
not as frequent as those seen among the races
Data on patient vintage, or prior ESRD time,
(tables 1.1-6). The
show that the northern half of the country has
greatest disparities are
the highest proportion of patients who survive
seen in transplant pa
longer than ten years with the disease (fig 1.26).
tients, with males ac counting for as much Figure 1.1 Odds ratio of developing kidney failure
by state, adjusted for age, gender, & race ESRD incident data for 1995 and 1996 are obtained from HCFA, while population data for the same time period are obtained from the U.S. Census Bureau. 1995-1996 data from Missouri used as baseline.
as 60% of the trans planted population.
Included in this chapter ♦ Maps of incident and prevalent rates of ESRD, overall and by primary diagnosis, gender, race.age group, and prior ESRD time ♦ Maps showing the differences in rates that are raw, smoothed, or adjusted and smoothed ♦ Tables of incident and prevalent counts by modality, as well as tables of patient demographics overall and by renal network
In the dialysis popula
♦ Projections of the number of incident and point prevalent pa tients in 2010
tion incident Native
♦ Graphs of incident rates for dialysis and transplant patients
CHAPTER
i
■ INCIDENCE
&
PREVALENCE
Prevalence, 1990
Incidence, 1990
J>A" ·Incidence, 1998
BL.
Whk JP
750 to 1,000 600 to 750 below 600
■ ■
750 to 1,000 600 to 750 below 600
Prevalence, 1998
Prevalence, percent change 1990-1998
Incidence, percent change 1990-1998
_~-^
■ B
*
i^ 1 ?
" *
^
T
:
Ψ
Figure 1.2 Incidence and prevalence of ESRD rates per million population, by HSAt unadjusted
■ 72 + ■ 58 to 72 ■ 46 to 58 34 to 46 ■ below 34
·
S39
S4o
· 2000
ATLAS
Table 1.1 Incident counts & rates hetnodialysis patients, 1998, rates adjusted for age, gender, & race The tables on this page are cre ated from a different dataset than that used to create the summary table in the Precis (table p.1 is updated through May 2000, and these tables through December 1999);direct comparisons, therefore, should not be made.
OF
ESRD
Number
Percent
Rate
of total
per million
STATES
% change
% change 1990-1994
1994-1998 5.0
461
0.9
6.0
3.2
14.3 37.4
76.9
4.1
1.7
366.5
7.1
6.5
14,022 11,780
25.8
756.8
6.3
2.9
21.7
751.8
9.2
8.8
Male Female
28,627
52.7
218.9
47.3
187.8
6.1 7.3
5.1
25,723
White Black
33,207
61.1
150.0
5.9
5.6
18,046 1,023
33.2
531.2
7.6
4.0
440.2
8.0
11.2
2,074
ι.ς 3.8
204.8
11.1
8.5
24,670
45.4
92.1
9.0
9.9
12,804
23.6
47.8
6.5
-0.3
Glomerulonephritis
6,315
11.6
23.6
2.5
Cystic kidney Other urologic
1,349 2,541
2.5
5.0
2.8
1.5 2.7
4.7
9.5
54,350
100.0
203.0
4.2 6.7
20-44 45-64 65-74 75+
Asian Diabetes Hypertension
All
20,316
Number
5.4
22.2 5.2
Percent
Rate
% change
% change
of total
per million
1990-1994
1994-1998
329
5.7
4.3
-0.9
20-44
1,174
11.6
-0.3
16.5 -4.0
45-64
2,452
20.5 42.7
44.2
2.8
3.3
65-74
1,209
21.1
4.6
2.1
575
10.0
65.3 36.7
10.2
4.3
0-19
75+ Male
2,969
51.7
22.7
1.9
1.6
Female
2,770
48.3
20.2
3.8
2.3
White
4,233
73.8
19.1
1.9
3.1
Black
1,200
20.9
35.3
2.7
-1.7
Native American Asian Diabetes
94
1.6
40.4
4.2
6.5
212
3.7
20.9
31.1
-0.1
2,496
9.3
3.5
4.9
0.5
-3.3 0.4
Hypertension
943
43.5 16.4
Glomerulonephritis
987
17.2
3.5 3.7
Cystic kidney
357
6.2
1.3
2.2
5.8
Other urologic
224
3.9
2.8
21.9
5,739
100.0
0.8 21.4
2.8
1.9
All
Table 1.3 Incident counts & rates transplant patients (patients with transplant as the first treatment modality), 1998, rates adjusted for age, gender, & race
THE UNITED
7,771
0-19
Native American
Table 1.2 Incident counts & rates peritoneal dialysis patients, 1998, rates adjusted for age, gender, & race
IN
Number
Percent
Rate
% change
% change
of total 11.9
per million
1990-1994
2.6
7.9
1994-1998 -3.4
7.5 11.6
6.6
-1.3
20.1
5.8
0-19 20-44
761
45-64
642
45.5 38.4
65-74
65
3.9
3.5
28.5
12.3
5
0.3
0.3
8.2
5.3
938 734
56.1
7.2 5.4
10.0
1.4
43.9
11.9
1.2
1,430
85.5
6.5
5.4
8.2
179
10.7
5.3
30.4
-21.9
13
0.8 3.0
5.6
9.6
0.0
50
4.9
12.7
0.0
264
15.8
1.0
9.3
2.4
75
4.5
0.3
9.6
1.9
Glomerulonephritis
276
16.5
1.0
4.4
3.7
Cystic kidney
242
14.5
0.9
1.7
17.6
78
4.7
0.3
3.6
17.9
1,672
100.0
6.2
10.8
1.3
75+ Male Female White Black Native American Asian Diabetes Hypertension
Other urologic All
199
1.4
CHAPTER
i
■ INCIDENCE
&
PREVALENCE
·
S41
Figure 1.3 Number of incident & point prevalent ESRD patients projected to 2010
700 -,
651,330
Number of patients • Projection 95% Confidence interval
Graphs are made using forecast ing and time-series analyses, with stepwise autoregressive models for incidence and expo nential smoothing models for prevalence. These projections use actua data from 1982-1997. The pro jected counts for 1998 are comparable t o the actual 1998 counts listed in Table p.l.
-400 -
2000
2002
2004
2006
2008
2010
Figure 1.4 Incident rates, males per million population, 1994— 1998 combined, by state, unadjusted
Figure 1.5 Incident rates,females per million population, 19941998 combined, by state, unadjusted
S42
·
2000
ATLAS
Figure 1.6 Unadjusted, unsmoothed incident rates
per million population, ESRD patients, 1998,byHSA Unsmoothed maps provide a vi sual display of data for individual HSAs. Although some patterns are apparent.geographic adjust ment for differences in neigh boring HSAs.along with weight ing of the data by the number of patients, are needed for a more precise depiction of re gional differences.
Figure 1.7 Unadjusted, smoothed incident rates
per million population, ESRD patients, 1998, byHSA The Bayesian smoothing model (described in Appendix A) is used here to reduce statistical differences between neighbor ing HSAs. When compared to fig ure 1.6, this map shows the im pact of adjusting for these differ ences as well as the effects of weighting the data on the num ber of patients in each HSA.
Figure 18 Adjusted, smoothed incident rates
per million population, ESRD patients, 1998, by HSA, adjusted for age, gender, & race Like the map in figure 1.7, this map is smoothed using the Bayesian model (described in Appendix A), which adjusts for differences over time due to pat terns of incident rates in prior years. It is also adjusted to ac count for differences in patient characteristics.
OF
ESRD
IN
THE
UNITED
STATES
CHAPTER
l
·
INCIDENCE
& PREVALENCE
Transplant, unadjusted & unsmoothed
Dialysis, unadjusted & unsmoothed
■ 250 to 300 ■ 200 to 250 below 200 Transplant, unadjusted & smoothed
Dialysis, unadjusted & smoothed
■ 250 to 300 ■ 200 to 250 below 200 Transplant, adjusted & smoothed
Dialysis, adjusted & smoothed
■
600 to 800
■
400 to 600 below 400
Figure 1.9 Prevalent rates, dialysis & transplant
per million population, 1998, by HSA Final maps are adjusted forage, race, and gender. Maps are smoothed using the Bayesian model; see Appendix A for a description of methods.
■ 250 to 300 ■ 200 to 250 below 200
· S43
S44
·
2000
ATLAS
Table 1.4 Point prevalent counts & rates hemodialysis patients alive on December 31". 1998, rates adjusted for age, gender & race The tables on this page are cre ated from a different dataset than that used to create the summary table in the Precis (table p.l is updated through May 2000, and these tables through December 1999);direct comparisons, therefore, should not be made.
OF
ESRD
0-19
of total
UNITED
Rate per million
STATES
% change
% change
1990-1994
1994-1998
939
0.5
12.1
1.1
4.3
20-44
31,318
15.9
310.1
4.4
45-64
71,478
36.3
1,268.5
5.6 8.3
65-74
51,767
26.3
2,804.0
5.4
75+
41,301
21.0
2,607.8
9.8 141
Male
102,829
52.3
764.0
9.1
7.3
93,974
47.8
663.5
9.1
6.8
105,881 80,324
53.8
467.9
8.3
7.1
40.8
2,271.3
9.7
6.7
3,645
1.9
1,420.1
13.6
10.6
6,953
3.5
651.8
12.9
8.7
Female White Black
7.6 10.7
Diabetes Hypertension
74,688
38.0
264.6
13.8
11.5
48,893
24.8
181.0
9.6
3.0
Glomerulonephritis
26,783
13.6
100.1
4.4
2.2
6,161 7,857
3.1
22.7
4.1
1.6
4.0
27.7
5.7
17.9
196,803
100.0
731.6
9.1
7.0
Cystic kidney Other urologic All
Table 1.5 Point prevalent counts & rates
Percent
Rate
% change
% change
Number
of total
per million
1990-1994
1994-1998
663
2.9 24.7
8.6
2.5
2.0
5,585
55.3
7.5
-5.3
45-64
9,183
40.6
163.0
9.7
-2.1
65-74
21.2
259.8
13.0
-4.8
75+
4,797 2,377
10.5
150.1
14.9
-0.3
Male
11,454
50.7
100.2
9.8
-3.9
Female
11,151
49.3
91.6
10.1
-2.5
White Black
15,228
67.4
78.7
26.7
198.7
8.8 11.7
-3.3
6,039 375
1.7
173.4
12.1
0.3
963
4.3
105.6
23.5
2.3
Diabetes
7,332
32.4
31.4
12.6
-1.5
Hypertension
4,127
18.3
17.6
-8.3
Glomerulonephritis
4,399
19.5
19.1
10.5 6.6
Cystic kidney
1,214
5.4
5.1
7.6
-4.4
890
3.9
3.4
8.8
8.1
22,605
100.0
84.0
10.0
-3.2
Percent
% change
% change
1990-1994
1994-1998 4.8
0-19 20-44
Native American Asian
Other urologic
All
Table 1.6 Point prevalent counts & rates transplant patients patients alive on December 31s1,1998, rates adjusted for age, gender, & race
THE
Percent Number
Native American Asian
peritoneal dialysis patients alive on December 31s1, 1998, rates adjusted for age, gender, & race
IN
0-19
Number
of total
Rate per million
3,702
-3.9
-5.7
5.4
36,826
4.2 41.7
47.9
20-44
364.6
6.0
3.4
45-64
39,758
45.0
705.6
13.1
10.5
65-74
7,237
8.2
392.0
25.5
15.0
788
0.9
49.8
24.6
32.6
75+ Male
52,526
59.5
374.0
9.2
Female
35,785
40.5
241.4
10.0
7.3 7.7
White
67,053
75.9
282.4
9.0
6.8
Black
16,851
19.1 1.2
11.0 12.1
9.4
1,045
456.6 418.4
3,362
3.8
294.8
12.8
11.2
Diabetes Hypertension
17,442
19.8
60.4
11.8
8.3
10,650
12.1
37.3
10.3
7.3
Glomerulonephritis
28.5 10.7
88.6
8.1
Cystic kidney
25,125 9,411
32.4
10.6
5.9 8.4
Other urologic All
2,765
3.1
9.7
10.2
5.2
88,311
100.0
328.3
9.5
7.4
Native American Asian
7.3
Diabetes, 1990
Diabetes, 1998
Diabetes, percent change 1990-1998
S46
·
2000
ATLAS
Figure 1.11 Incident rates by age per million population, unadjusted
OF
ESRD
IN
THE
UNITED
STATES
Transplant
Dialysis
1,000
800
400
200
Figure 1.12 Incident rates by gender per million population, unadjusted 350
Transplant
Dialysis
9 -i
Male Female
300 250 200 150 100 50 0 1990
Figure 1.13 Incident rates by race & ethnicity per million population, unadjusted The sharp rise in incident rates for Hispanic patients after 1994 can be explained in part by the introduction of the revised Medi cal Evidence Form (2728), which contains more specific questions on race and ethnicity.
800
1992
1994
1996
Dialysis
1990
20
■ White Black - Native American Asian Hispa
600
1998
1992
1994
1996
1992
1994
1996
Transplant
400
1990
1992
1996
1990
CHAPTER
l
·
INCIDENCE
&
PREVALENCE
·
S47
Figure 1.14 Incident rates by primary diagnosis
140
Dialysis
per million population, unadjusted
Transplant • Diabetes Hypertension 1 Glomerulonephritis Cystic kidney
^
>
*
,
60 40
0.2
20 0 1990
1992
1996
1994
1990
1992
1996
1998
Figure 1.15 Incident & prevalent counts by Dialysis
Transplant
85+ 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 ■ ■ ■ ■ · 30-34 ■■■· 25-29 ■ · · ■ ■ ▼ 20-24 15-19 ·-"*> 10-14< 5-9< 0-4 < '
·
•
Incidence
τ
Prevalence
age group
199»
t
·
·τ •
ψ
•
¥■■■■
f ▼
|r
1
1
1
1
1
1
5,000
10,000
15,000
20,000
25,000
30,000
""i 1,000
1 3,000
1 5,000
1 7,000
1 9,000
1 11,000
Number of patients
Figure 1.16 Median age at incidence by race White
Native American
Black
1998
•
Asian
w
1997
T ■■■y
ψ
·
y
1996
·
■
■
·
·
■
▼-'·
· ■
·
Dialysis Transplant
·
«r
·
·
■
■
-
■
■
1995
■ ■ ■ ■ y
···
• · · ·τ
1994
■ ■ ■ ■ y
···
■··■▼
1993 1992
■■■¥
ψ
·■■▼
1991
·
■
·
·
·
■
■
■
·
■■Ψ
·
1990 25
35
45
55
65
1
1
1
1
1
25
35
45
55
65
1 25
Age in years
y 1 35
■ '
■
1 45
■
■
·
·
·
1
55
1
25
35
1
1
1
45
55
65
S48
·
2000
ATLAS
OF
ESRD
IN
THE
UNITED
STATES
Table 1.7 Primary disease demographics
column percent, incident patients, 1994-1998 combined Patients with race designated as "other"or"unknown"are included in the total counts.
%
%
Total
%of
Median
pts.
total
age
All ESRD (reference)
382,490
100.0
Diabetes
150,978
39.5
63 64
100 1.6
100 40.9
34,997
9.1
57
30.5
8,490
2.2
47
14,429 96,268
3.8 25.2
66 70
9.8 6.7 5.1
2.8
52
24.9
Neoplasms/tumors
10,801 6,498
17.0 3.4
1.7
69
0.6
1.2
Miscellaneous conditions
12,299
3.2
56
4.5
3.7
DIALYSIS
Glomerulonephritis Secondary GN/vasculitis Interstitial neph/pyeloneph. HTN/large vessel disease Cystic/hereditary/congenital
<20 20-64
%
>64
%
Male
%
Female
%
White
% % Nat.
%
Black
Amer.
Asian
%
Hisp.
100
100
100
100
100
100
35.3
44.1
39.8
37.9
100 62.4
100 42.2
58.8
10.2
39.0 7.4
9.9
7.2
7.9
14.8
1.2
10.4 1.4
7.7
3.0
3.2
2.2
2.3
2.1
2.2
9.1 2.4
3.2
4.3 34.5
4.0 26.9
3.5 23.3
4.7 23.7
2.1 30.4
2.0 11.5
3.2 21.8
16.2
1.6 2.3
3.0
2.6 1.4
3.6
1.4
1.5
2.1
2.6
2.0
2.1
1.1
3.9
2.4
3.0
4.1
1.0 1.4
0.8 1.1
2.0
3.9
3.2
4.0
2.8
2.4
4.1
3.5
9.2
8.6
6.9
10.7
8.0
7.7
1.8
2.7
1.0
Etiology uncertain
13,712
3.6
68
7.0
2.8
2.6 4.4
Missing
34,018
8.9
51
9.2
14.6
2.7
All ESRD (reference)
8,117
100.0
40
100
100
100
100
100
100
100
100
1,310 1,134
16.1
42
0.2
16.3
18.4
19.4
6.7
39
14.1
14.9
9.9
19.4
20.6
2.2
2.1
1.1
1.2
4.8
2.4
5.5
4.5 4.2
3.9 4.6
3.9 4.2
5.2 4.2
2.0 6.2
1.2
5.5
31.5
10.9
6.2 10.5 8.4
6.5
46 39
6.9 0.7
2.3 5.3 3.7
1.8
362 340 1124
30 34
13.8 3.4
15.0 27.4
176
9.3 3.1
9.1 12.7
16.0
14.0
19.3 14.9
100 11.4
100
Diabetes
15.1
12.1
16.2
7.8
8.1 8.1
2.8 6.7
8.8 17.9
TRANSPLANT
Glomerulonephritis Secondary GN/vasculitis Interstitial neph./pyeloneph. HTN/large vessel disease Cystic/hereditary/congenital
17
13.8 0.2
50
0.3
0.2
0.2
0.2
0.2
0.2
0.0
0.0
0.0
Miscellaneous conditions
197
2.4
41
4.0
2.2
1.5
2.3
2.6
2.7
1.9
3.2
1.6
4.7
Etiology uncertain
229
2.8
40
2.9
2.8
0.0
2.0
6.6
4C
2.5 48.C
3.1
39.8
3.0 39.0
2.6
3,228
2.0 41.9
40.3
39.C
33.6
55.9
30.6
56.C
8.8
Total
%of
Median
pts.
total
age
382,490
100.0 39.5
63 64
Neoplasms/tumors
Missing
Table 1.8 Primary disease demographics
row percent, incident patients, 1994-1998 combined Patients with race designated as "other"or"unknown"are included in the total counts.
DIALYSIS All ESRD (reference) Diabetes Glomerulonephritis Secondary GN/vasculitis Interstitial neph./pyeloneph. HTN/large vessel disease Cystic/hereditary/congenital Neoplasms/tumors Miscellaneous conditions Etiology uncertain Missing
150,978 34,997
%
%
<20 20-64
%
>64
%
%
%
% % Nat.
Male
Female
White
Black
%
%
Amer.
Asian
Hisp.
1.3
51.3
47.5
52.9
47.1
1.5
53.1 57.4
46.9 38.4
47.4
52.6
61.5 62.1
30.7
0.1
29.5
2.4
3.3 3.6
9.2 13.7
60.4
39.6
66.2
24.3
1.3
5.4
68.3
26.1
33.2
66.8
31.5
1.4
3.3
9.1 9.7
43.9
53.9
56.4
43.6
61.3 77.4
43.5
0.7
26.5
55.9
44.1
57.8 79.3
2.8 2.9
6.5
56.5
17.0 37.1
0.8
65.1
14.8
0.8
2.5
8.3
9.1
57
2.2
47
4.3 5.7
14,429
3.8
96,268 10,801
25.2
66 70
2.3 0.3
2.8 1.7
52
11.3
34.6 62.2
69
0.5
34.9
64.6
61.6
38.4
76.9
19.6
0.8
1.6
5.1
3.2
56 68
1.8 2.5
59.6
38.6
64.3
35.7
39.4
0.7
1.2
5.8
58.0
3.8
8.9
45.3
47.9
23.6 37.1
1.0
1.3
57.3 54.7
42.7
51
39.5 84.2
56.8 68.9
1.3
2.9
1.9
8,490
6,498 .12,299 13,712 34,018
3.6 8.9
14.5
5.9
TRANSPLANT All ESRD (reference)
8,117
14.9
81.7
3.4
0.8
3.1
3.4
0.2
97.9
1.9
42.9
72.5 82.4
20.6
42
57.5 57.1
42.5
1,310
100.0 16.1
40
Diabetes
14.6
0.9
1.3
3.1
Glomerulonephritis
1,134
14.0
39
10.0
86.9
3.1
58.0
42.0
77.4
14.6
1.1
4.6
6.6
Secondary GN/vasculitis Interstitial neph./pyeloneph.
176 362
2.2
30
21.0
1.7
33.0
17.0
1.7
3.4
34
4.7
50.0
85.9
9.1
1.1
0.8
8.5 4.1
HTN/large vessel disease
340
4.2
46
22.9 2.6
67.0 50.0
76.1
4.5
77.3 72.4
8.5
57.6
42.4
30.3
1.5
2.1
7.1
1124
13.8
39
33.9
2.0
62.7
37.3
63.2 84.7
11.7
0.4
1.5
4.4
70.6
0.0
Cystic/hereditary/congenital Neoplasms/tumors Miscellaneous conditions Etiology uncertain Missing
88.8 64.1
17
0.2
50 41
73.6
2.0
58.8 54.8
41.2 45.2
79.2
23.5 15.7
0.0
2.4
23.5 24.4
76.5
197
1.0
0.0 2.0
229
2.8
40
10.5
86.5
3.1
53.3
46.7
73.4
20.5
0.0
2.2
7.9
3,228
39.8
40
15.7
80.2
4.1
58.3
41.7
61.2
28.9
0.6
4.4
0.7
6.6
CHAPTER
Total
%of
patients
%
i
·
INCIDENCE
%
%
%
PREVALENCE
%
·
S49
Table 1.9
1
3,376
4.0
257
64
38.3
81.8
15.0
1.5
0.2
3.5
Patient demographics by ESRD network incident dialysis patients, 1998
2
6,058
7.2
62
37.6
57.3
2,952
3.5
63
41.5
58.5
4
4,411
5.3
63
39.9
3.6 2.4 0.8
7.8 7.9 1.4
Patients with race designated as "other"or"unknown"are included in the total counts.
5
5,229
6.3
376
61
50.2
1.5
0.2
1.3
6
6,799
8.1
367
59
39.2 41.1
72.9 46.7
33.6 34.9 24.9
0.4
3
338 371 354
57.6
0.8
0.7
Network
Mean
total
Rate per million
age
Diabetes
White
Black
%Nat.
&
Amer.
Asian
Hispanic
0.1 0.2
7
5,038
6.0
348
63
35.7
40.2 67.7
30.0
0.6 1.1
0.2
9.4
8
4,399
5.3
358
60
39.4
46.9
51.9
0.5
0.4
0.1
9
6,510
315
73.4
25.1
0.4
0.2
1.1
3,891
37.0
60.2
36.1
1.6
0.2
5.8
11
5,632
6.7
330 279
62 62
43.0
10
7.8 4.7
62
41.6
1.3
4.2
286
62
41.3
22.3
0.7
2.9 0.7
2.2
3,520
71.1 75.1
23.9
12 13 14
3,795
4.5
376
60
43.5
48.4
46.3
0.5
4.1
0.9
6,192
7.4
59
5.7
4.3
60
77.0
24.2 7.9
3.4
3,611
47.2 47.7
64.1
15
324 257
2.5
16
2,123
188
60
40.0
80.9
8.5
6.1
17
3,922 6,154
2.5 4.7
10.2 3.7
35.3 18.4
301
61
55.1
15.8
25.2
68.3
17.2
62.5
30.6
11.0 3.4
18 All
Network 1
62
83,612
100.0
308 311
44.9 44.2
61
41.4
Total
%of
Rate per
Mean
patients
total
million
age
Diabetes
9,229
689
63
34.1
969
60
984
7.4
%
%
%
% Nat.
White 77.6
Black 19.0
Amer.
32.7
50.0
41.7
61
35.4
52.9
2.2
4.2 14.4
1.2 0.5
25.7
1.6
8.5
%
% Hispanic
3.5
Asian 0.3 0.7
41.5
2.4
0.2
8.2
1.7
4.1
2
17,597
4.0 7.7
3
7,954
3.5
4
11,705
5.1
918
62
34.4
62.3
35.5
0.9
0.2
1.8
5 6
14,807
6.4
1,041
59
33.4
36.6
1.7
21,743
9.5
1,152
58
35.0
29.1
60.4 67.1
0.3 2.1
2.5
1.2
8.6
7
12,863
5.6
869
61
32.6
56.6
41.0
1.2
0.3
8.7
13,758
6.0
1,102
59
34.3
35.8
63.1
0.5
0.4
0.2
9
16,567
7.2
789
61
37.1
64.3
34.1
0.6
0.2
10 11
10,232
4.5
851
61
32.7
52.5
43.7
2.1
1.0 5.4
14,875
6.5
705
61
36.9
63.6
31.5
1.5
0.3 2.9
12
9,093
4.0
724
37.0
67.9
28.7
13
10,461
4.5
1,023
61 59
36.9
40.3
54.2
0.9 0.7
14
18,607
8.1
951
58
43.1
61.2
31.6
15
9,416
4.1
647
59
46.0
71.4
9.2
2.2 2.4
16 17
5,851
2.5
503
59
36.8
78.3
10.0
10,224
4.4
768
60
40.2
49.1 63.1 54.1
18
14,936
6.5
736
60
40.1
All
229,918
100.0
855
60
36.5
Total
%of
Rate per
Mean
%
%
2.3 2.6
4.2
1.2
2.2
32.1
15.0 4.1
20.5
6.8
18.1
28.0
1.2
14.9
19.2
12.3
0.8
27.7
38.8
3.6
1.8
8.6
%
%Nat.
%
4.8
%
patients
total
million
Amer.
Asian
Hispanic
5.0
325
Diabetes 18.7
Black
4,357
age 47
White
1
85.7
10.6
2
5,286
6.1
291
45
15.2
72.8
19.4
2.0 4.4
0.6 0.9
2.8 7.6
Network
3
2,255
2.6
279
46
18.8
70.7
23.0
4.1
0.3
8.5
4
4,900
5.6
384
47
19.6
78.0
19.3
1.7
0.3
1.6
5
4,309
4.9
303
46
17.5
60.8
34.7
3.0
0.5
1.2
6
5,503
6.3
292
45
18.0
60.9
35.4
2.1
1.1
2.0
7
4,177
4.8
282
47
17.7
75.2
21.7
2.3
0.4
7.7
8
4,197
4.8
336
44
15.6
66.0
32.5
0.9
0.2
0.3
9
7,250 4,284
8.3
345
46
19.4
79.7
18.3
1.3
0.3
0.6
4.9 10.7
356
45
19.9
72.7
22.5
2.7
0.6
5.7
440
46
27.0
83.8
12.1
1.6
1.2
45 45
23.0
83.8
13.2
20.4
66.5
28.6
1.6 1.4
1.8 1.0 2.9
1.4
10 11 12
9,289 4,457
13
3,084
3.5
355 302
14
5,947
6.8
304
45
19.7
76.0
18.4
2.6
0.5
19.7
15 16
4,571
5.2
314
45
84.4
5.6
2.8
312
46
86.4
4.7
5.5
17
4,077
4.2 4.7
5.2 2.7
10.6
3,630
26.0 24.5
306
46
18.2
64.5
9.8
20.0
273 324
46
17.6
73.9
11.2
11.2
1.3 1.1
11.6 21.4
46
20.1
75.3
18.5
3.7
1.2
6.0
5.1
18
5,547
6.4
All
87,120
100.0
Patients with race designated as "other"or"unknown"are included in the total counts.
1.1
8
1.3
Table 1.10 Patient demographics by ESRD network prevalent dialysis patients, 1998
1.4
3.0
Table 1.11 Patient demographics by ESRD network prevalent transplant patients, 1998 Patients with race designated as "other"or"unknown"are included in these totals.
S50
·
2 0 0 0
A T L A S
OF
E S R D
IN
HE
Whites, 1990
U N I T E D
S T A T E S
Blacks, 1990
■ 530 to 710 ■ 480 to 530 below 480 Whites, 1998
M 530 to 710 ■ 480 to 530 below 480 Whites, percent change 1990-1998
Blacks, percent change 1990-1998
■ 58 to 66 49 to 58 ■ below 49 Figure 1.17 Prevalent rates by race per million population, point prevalent patients on December 31'' of each year, by HSA, adjusted for age & gender Maps are smoothed using the Bayesian model; see Appendix A for a description of methods.
■ 44 to 53 37 to 44 m below 37
CHAPTER
Ages 20-44,1990
i
·
INCIDENCE
Ages 20-44,1998
■ 1,040 to 1,130 ■ 860 to 1,040 H 820 to 860 ■ below 820 Ages 45-64,1990
& PREVALENCE
Ages 20-44, percent change 1990-1998
■ 1,040 to 1,130 ■ 860 to 1,040 Β 820 to 860 ■ ■ : below 820 Ages 45-64,1998
■ 2,470 to 2,810 ■ 1,740 to 2,470 ■ 1,600 to 1,740 below 1,600 Ages 65-74,1990
■ 2,470 to 2310 ■ 1,740 to 2,470 ■ 1,600 to 1,740 below 1,600 Ages 64-74,1998
3560 H ■ 3,030 to 3,560 U 1,930 to 3,030 ■ 1,650 to 1,930 below 1,650
■ 3,030 to 3,560 ■ 1,930 to 3,030 ■ 1,650 to 1,930 : below 1,650 Ages 75+, 1990
Ages 65-74, percent change 1990-1998
Ages 75+, 1998
■ ■ ■ ■
2360 + 2260 to 2,860 1330 to 2,260 1,070 to 1,330 below 1,070
Figure 1.18 Prevalent rates by age per million population, point prevalent patients on December 3Γ' of each year, by HSA, adjusted for gender & race Maps are smoothed using the Bayesian model; see Appendix A for a description of methods.
Ages 75+, percent change 1990-1998
■ ■ ■ • ■:
2360 H 2260 to 2360 1330 to 2,260 1,070 to 1,330 below 1,070
· S51
S52
■ 2000
ATLAS
OF
ESRD
IN
THE
UNITED
STATES
Figure 1.19 Prior ESRD time prevalent patients
0to6 months
6to<12 months
1to<2 years
2to<4 years
4to<6 years
10+years
6to<10 years
Figure 1.20 Percent of patients with 0-6 months of prior ESRD time prevalent ESRD patients, 1998, by HSA, unadjusted The distribution of patients by vintage, or prior ESRD time, is determined bythe combination of incident rates and length of survival.
■ ■ ■ ■
Figure 1.21 Percent of patients with 6-12 months of prior ESRD time prevalent ESRD patients, 1998, by HSA, unadjusted
3.0 + 2.6 to 3.0 2.2 to 2.6 1.6 to 2.2 below 1.6
CHAPTER
i
·
INCIDENCE
&
PREVALENCE
·
S53
Figure 1.22 Percent of patients with 1 - 2 years of prior ESRD time
prevalent ESRD patients, 1998, byHSA, unadjusted
■ ■ ■ ■
21.8 + 21.0 to 21.8 20.2 to 21.0 19.1 to 20.2 below 19.1
Figure 1.23 Percent of patients with 2-4 years of prior ESRD time
prevalent ESRD patients, 1998, byHSA, unadjusted
Figure 1.24 Percent of patients with 4-6 years of prior ESRD time
prevalent ESRD patients, 1998, by HSA, unadjusted
■ 17.2 + ■ 16.5 to 172 5.8 to 165 14.6 to 15B below 14.6
S 54
·
2000
ATLAS
Figure 1.25 Percent of patients with 6-10 years of prior ESRD time prevalent ESRD patients, 1998, by HSA, unadjusted
Figure 1.26 Percent of patients with greater than 10 years of prior ESRD time prevalent ESRD patients, 1998, by HSA, unadjusted
OF
ESRD
IN
THE
UNITED
STATES
ESRD
The absence of romance in my history will, I fear, detract somewhat from its interest; but I shall be content if it is judged useful by those inquirers who desire an exact knowledge of the past as an aid to the interpretation of the future, which in the course of human things must resemble if it does not reflect it. Thucydides, Peloponnesian War
American Journal of Kidney Diseases, Vol 36, No 6, Suppl 2 (December), 2000: pp S37-S54
S38 · 2000
ATLAS
OF
ESRD
IN
THE
UNITED
STATES
The ESRD population in the United States and
Americans have the highest rate of diabetes, but
its territories continues to increase. Incident
the lowest rate of hypertension/large vessel dis
counts are projected to rise to 172,667 by 2010,
ease. Rates of diabetes are also high among His
while 1998 prevalent counts—influenced by in
panic patients. The highest rate of glomerulone-
creased rates of disease, better dialysis therapy and
phritis is seen in Asian patients, in whom the
anemia control, improved graft survival, and
disease is twice as frequent as in black patients
lower death rates—are projected to rise approxi
(table 1.7). These differences tend to dissipate in
mately 77% to exceed 660,000 in 2010 (fig 1.3).
the transplant population, though glomerulonephritis is seen in almost a quarter of Native Ameri
Racial differences are evident across modalities
can and Hispanic transplant patients.
in both incident and prevalent populations (tables 1.1-6). Between 1994 and 1998 the greatest per
It is unclear why the rate of diabetes continues to
centage increases in the number of hemodialysis
increase—even when adjusted for age, gender,
patients have been in the Native American and
and race—while rates of non-diabetic incidence
Asian populations. The number of prevalent pa
remain steady (table p. 1). While low protein di
tients per million population, however, is high
ets, blood pressure control, and ACE inhibitors
est for black and Native American patients—
have all been available for some time, they do not
All data underlying the compared to that of white patients, the rate is appear to have influenced the diabetic popula almost five times higher for black hemodialysis
tion. The dramatic rise in diabetes in the inci
figures in this chapter, patients, and three times higher for Native Ameri dent dialysis population maybe related to the ad cans on the same modality. While the number of
vancing obesity, carbohydrate intolerance, and
as well as additional related prevalent black transplant patients has increasedinsulin resistance suggested by recent trends of 9% since 1994, second only to the increase in the data, may be viewed &
who are transplanted at the beginning of ESRD downloaded at
increased weight and body mass index at initia
Asian population, the number of black patientstion of therapy (fig 1.14). Early clinical trials do suggest that, while glycemic control does not stop
therapy has decreased 22%, suggesting that black or reverse the course of advancing renal failure, it patients are increasingly likely to begin ESRD
can slow the disease by 30-50%. It may be that
www. usrds. org. treatment with dialysis instead of transplantation. more aggressive glycemic control and treatment of lipid disorders are needed to lower the diabetic Gender differences are
incident rate.
not as frequent as those seen among the races
Data on patient vintage, or prior ESRD time,
(tables 1.1-6). The
show that the northern half of the country has
greatest disparities are
the highest proportion of patients who survive
seen in transplant pa
longer than ten years with the disease (fig 1.26).
tients, with males ac counting for as much Figure 1.1 Odds ratio of developing kidney failure
by state, adjusted for age, gender, & race ESRD incident data for 1995 and 1996 are obtained from HCFA, while population data for the same time period are obtained from the U.S. Census Bureau. 1995-1996 data from Missouri used as baseline.
as 60% of the trans planted population.
Included in this chapter ♦ Maps of incident and prevalent rates of ESRD, overall and by primary diagnosis, gender, race.age group, and prior ESRD time ♦ Maps showing the differences in rates that are raw, smoothed, or adjusted and smoothed ♦ Tables of incident and prevalent counts by modality, as well as tables of patient demographics overall and by renal network
In the dialysis popula
♦ Projections of the number of incident and point prevalent pa tients in 2010
tion incident Native
♦ Graphs of incident rates for dialysis and transplant patients
CHAPTER
i
■ INCIDENCE
&
PREVALENCE
Prevalence, 1990
Incidence, 1990
J>A" ·Incidence, 1998
BL.
Whk JP
750 to 1,000 600 to 750 below 600
■ ■
750 to 1,000 600 to 750 below 600
Prevalence, 1998
Prevalence, percent change 1990-1998
Incidence, percent change 1990-1998
_~-^
■ B
*
i^ 1 ?
" *
^
T
:
Ψ
Figure 1.2 Incidence and prevalence of ESRD rates per million population, by HSAt unadjusted
■ 72 + ■ 58 to 72 ■ 46 to 58 34 to 46 ■ below 34
·
S39
S4o
· 2000
ATLAS
Table 1.1 Incident counts & rates hetnodialysis patients, 1998, rates adjusted for age, gender, & race The tables on this page are cre ated from a different dataset than that used to create the summary table in the Precis (table p.1 is updated through May 2000, and these tables through December 1999);direct comparisons, therefore, should not be made.
OF
ESRD
Number
Percent
Rate
of total
per million
STATES
% change
% change 1990-1994
1994-1998 5.0
461
0.9
6.0
3.2
14.3 37.4
76.9
4.1
1.7
366.5
7.1
6.5
14,022 11,780
25.8
756.8
6.3
2.9
21.7
751.8
9.2
8.8
Male Female
28,627
52.7
218.9
47.3
187.8
6.1 7.3
5.1
25,723
White Black
33,207
61.1
150.0
5.9
5.6
18,046 1,023
33.2
531.2
7.6
4.0
440.2
8.0
11.2
2,074
ι.ς 3.8
204.8
11.1
8.5
24,670
45.4
92.1
9.0
9.9
12,804
23.6
47.8
6.5
-0.3
Glomerulonephritis
6,315
11.6
23.6
2.5
Cystic kidney Other urologic
1,349 2,541
2.5
5.0
2.8
1.5 2.7
4.7
9.5
54,350
100.0
203.0
4.2 6.7
20-44 45-64 65-74 75+
Asian Diabetes Hypertension
All
20,316
Number
5.4
22.2 5.2
Percent
Rate
% change
% change
of total
per million
1990-1994
1994-1998
329
5.7
4.3
-0.9
20-44
1,174
11.6
-0.3
16.5 -4.0
45-64
2,452
20.5 42.7
44.2
2.8
3.3
65-74
1,209
21.1
4.6
2.1
575
10.0
65.3 36.7
10.2
4.3
0-19
75+ Male
2,969
51.7
22.7
1.9
1.6
Female
2,770
48.3
20.2
3.8
2.3
White
4,233
73.8
19.1
1.9
3.1
Black
1,200
20.9
35.3
2.7
-1.7
Native American Asian Diabetes
94
1.6
40.4
4.2
6.5
212
3.7
20.9
31.1
-0.1
2,496
9.3
3.5
4.9
0.5
-3.3 0.4
Hypertension
943
43.5 16.4
Glomerulonephritis
987
17.2
3.5 3.7
Cystic kidney
357
6.2
1.3
2.2
5.8
Other urologic
224
3.9
2.8
21.9
5,739
100.0
0.8 21.4
2.8
1.9
All
Table 1.3 Incident counts & rates transplant patients (patients with transplant as the first treatment modality), 1998, rates adjusted for age, gender, & race
THE UNITED
7,771
0-19
Native American
Table 1.2 Incident counts & rates peritoneal dialysis patients, 1998, rates adjusted for age, gender, & race
IN
Number
Percent
Rate
% change
% change
of total 11.9
per million
1990-1994
2.6
7.9
1994-1998 -3.4
7.5 11.6
6.6
-1.3
20.1
5.8
0-19 20-44
761
45-64
642
45.5 38.4
65-74
65
3.9
3.5
28.5
12.3
5
0.3
0.3
8.2
5.3
938 734
56.1
7.2 5.4
10.0
1.4
43.9
11.9
1.2
1,430
85.5
6.5
5.4
8.2
179
10.7
5.3
30.4
-21.9
13
0.8 3.0
5.6
9.6
0.0
50
4.9
12.7
0.0
264
15.8
1.0
9.3
2.4
75
4.5
0.3
9.6
1.9
Glomerulonephritis
276
16.5
1.0
4.4
3.7
Cystic kidney
242
14.5
0.9
1.7
17.6
78
4.7
0.3
3.6
17.9
1,672
100.0
6.2
10.8
1.3
75+ Male Female White Black Native American Asian Diabetes Hypertension
Other urologic All
199
1.4
CHAPTER
i
■ INCIDENCE
&
PREVALENCE
·
S41
Figure 1.3 Number of incident & point prevalent ESRD patients projected to 2010
700 -,
651,330
Number of patients • Projection 95% Confidence interval
Graphs are made using forecast ing and time-series analyses, with stepwise autoregressive models for incidence and expo nential smoothing models for prevalence. These projections use actua data from 1982-1997. The pro jected counts for 1998 are comparable t o the actual 1998 counts listed in Table p.l.
-400 -
2000
2002
2004
2006
2008
2010
Figure 1.4 Incident rates, males per million population, 1994— 1998 combined, by state, unadjusted
Figure 1.5 Incident rates,females per million population, 19941998 combined, by state, unadjusted
S42
·
2000
ATLAS
Figure 1.6 Unadjusted, unsmoothed incident rates
per million population, ESRD patients, 1998,byHSA Unsmoothed maps provide a vi sual display of data for individual HSAs. Although some patterns are apparent.geographic adjust ment for differences in neigh boring HSAs.along with weight ing of the data by the number of patients, are needed for a more precise depiction of re gional differences.
Figure 1.7 Unadjusted, smoothed incident rates
per million population, ESRD patients, 1998, byHSA The Bayesian smoothing model (described in Appendix A) is used here to reduce statistical differences between neighbor ing HSAs. When compared to fig ure 1.6, this map shows the im pact of adjusting for these differ ences as well as the effects of weighting the data on the num ber of patients in each HSA.
Figure 18 Adjusted, smoothed incident rates
per million population, ESRD patients, 1998, by HSA, adjusted for age, gender, & race Like the map in figure 1.7, this map is smoothed using the Bayesian model (described in Appendix A), which adjusts for differences over time due to pat terns of incident rates in prior years. It is also adjusted to ac count for differences in patient characteristics.
OF
ESRD
IN
THE
UNITED
STATES
CHAPTER
l
·
INCIDENCE
& PREVALENCE
Transplant, unadjusted & unsmoothed
Dialysis, unadjusted & unsmoothed
■ 250 to 300 ■ 200 to 250 below 200 Transplant, unadjusted & smoothed
Dialysis, unadjusted & smoothed
■ 250 to 300 ■ 200 to 250 below 200 Transplant, adjusted & smoothed
Dialysis, adjusted & smoothed
■
600 to 800
■
400 to 600 below 400
Figure 1.9 Prevalent rates, dialysis & transplant
per million population, 1998, by HSA Final maps are adjusted forage, race, and gender. Maps are smoothed using the Bayesian model; see Appendix A for a description of methods.
■ 250 to 300 ■ 200 to 250 below 200
· S43
S44
·
2000
ATLAS
Table 1.4 Point prevalent counts & rates hemodialysis patients alive on December 31". 1998, rates adjusted for age, gender & race The tables on this page are cre ated from a different dataset than that used to create the summary table in the Precis (table p.l is updated through May 2000, and these tables through December 1999);direct comparisons, therefore, should not be made.
OF
ESRD
0-19
of total
UNITED
Rate per million
STATES
% change
% change
1990-1994
1994-1998
939
0.5
12.1
1.1
4.3
20-44
31,318
15.9
310.1
4.4
45-64
71,478
36.3
1,268.5
5.6 8.3
65-74
51,767
26.3
2,804.0
5.4
75+
41,301
21.0
2,607.8
9.8 141
Male
102,829
52.3
764.0
9.1
7.3
93,974
47.8
663.5
9.1
6.8
105,881 80,324
53.8
467.9
8.3
7.1
40.8
2,271.3
9.7
6.7
3,645
1.9
1,420.1
13.6
10.6
6,953
3.5
651.8
12.9
8.7
Female White Black
7.6 10.7
Diabetes Hypertension
74,688
38.0
264.6
13.8
11.5
48,893
24.8
181.0
9.6
3.0
Glomerulonephritis
26,783
13.6
100.1
4.4
2.2
6,161 7,857
3.1
22.7
4.1
1.6
4.0
27.7
5.7
17.9
196,803
100.0
731.6
9.1
7.0
Cystic kidney Other urologic All
Table 1.5 Point prevalent counts & rates
Percent
Rate
% change
% change
Number
of total
per million
1990-1994
1994-1998
663
2.9 24.7
8.6
2.5
2.0
5,585
55.3
7.5
-5.3
45-64
9,183
40.6
163.0
9.7
-2.1
65-74
21.2
259.8
13.0
-4.8
75+
4,797 2,377
10.5
150.1
14.9
-0.3
Male
11,454
50.7
100.2
9.8
-3.9
Female
11,151
49.3
91.6
10.1
-2.5
White Black
15,228
67.4
78.7
26.7
198.7
8.8 11.7
-3.3
6,039 375
1.7
173.4
12.1
0.3
963
4.3
105.6
23.5
2.3
Diabetes
7,332
32.4
31.4
12.6
-1.5
Hypertension
4,127
18.3
17.6
-8.3
Glomerulonephritis
4,399
19.5
19.1
10.5 6.6
Cystic kidney
1,214
5.4
5.1
7.6
-4.4
890
3.9
3.4
8.8
8.1
22,605
100.0
84.0
10.0
-3.2
Percent
% change
% change
1990-1994
1994-1998 4.8
0-19 20-44
Native American Asian
Other urologic
All
Table 1.6 Point prevalent counts & rates transplant patients patients alive on December 31s1,1998, rates adjusted for age, gender, & race
THE
Percent Number
Native American Asian
peritoneal dialysis patients alive on December 31s1, 1998, rates adjusted for age, gender, & race
IN
0-19
Number
of total
Rate per million
3,702
-3.9
-5.7
5.4
36,826
4.2 41.7
47.9
20-44
364.6
6.0
3.4
45-64
39,758
45.0
705.6
13.1
10.5
65-74
7,237
8.2
392.0
25.5
15.0
788
0.9
49.8
24.6
32.6
75+ Male
52,526
59.5
374.0
9.2
Female
35,785
40.5
241.4
10.0
7.3 7.7
White
67,053
75.9
282.4
9.0
6.8
Black
16,851
19.1 1.2
11.0 12.1
9.4
1,045
456.6 418.4
3,362
3.8
294.8
12.8
11.2
Diabetes Hypertension
17,442
19.8
60.4
11.8
8.3
10,650
12.1
37.3
10.3
7.3
Glomerulonephritis
28.5 10.7
88.6
8.1
Cystic kidney
25,125 9,411
32.4
10.6
5.9 8.4
Other urologic All
2,765
3.1
9.7
10.2
5.2
88,311
100.0
328.3
9.5
7.4
Native American Asian
7.3
Diabetes, 1990
Diabetes, 1998
Diabetes, percent change 1990-1998
S46
·
2000
ATLAS
Figure 1.11 Incident rates by age per million population, unadjusted
OF
ESRD
IN
THE
UNITED
STATES
Transplant
Dialysis
1,000
800
400
200
Figure 1.12 Incident rates by gender per million population, unadjusted 350
Transplant
Dialysis
9 -i
Male Female
300 250 200 150 100 50 0 1990
Figure 1.13 Incident rates by race & ethnicity per million population, unadjusted The sharp rise in incident rates for Hispanic patients after 1994 can be explained in part by the introduction of the revised Medi cal Evidence Form (2728), which contains more specific questions on race and ethnicity.
800
1992
1994
1996
Dialysis
1990
20
■ White Black - Native American Asian Hispa
600
1998
1992
1994
1996
1992
1994
1996
Transplant
400
1990
1992
1996
1990
CHAPTER
l
·
INCIDENCE
&
PREVALENCE
·
S47
Figure 1.14 Incident rates by primary diagnosis
140
Dialysis
per million population, unadjusted
Transplant • Diabetes Hypertension 1 Glomerulonephritis Cystic kidney
^
>
*
,
60 40
0.2
20 0 1990
1992
1996
1994
1990
1992
1996
1998
Figure 1.15 Incident & prevalent counts by Dialysis
Transplant
85+ 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 ■ ■ ■ ■ · 30-34 ■■■· 25-29 ■ · · ■ ■ ▼ 20-24 15-19 ·-"*> 10-14< 5-9< 0-4 < '
·
•
Incidence
τ
Prevalence
age group
199»
t
·
·τ •
ψ
•
¥■■■■
f ▼
|r
1
1
1
1
1
1
5,000
10,000
15,000
20,000
25,000
30,000
""i 1,000
1 3,000
1 5,000
1 7,000
1 9,000
1 11,000
Number of patients
Figure 1.16 Median age at incidence by race White
Native American
Black
1998
•
Asian
w
1997
T ■■■y
ψ
·
y
1996
·
■
■
·
·
■
▼-'·
· ■
·
Dialysis Transplant
·
«r
·
·
■
■
-
■
■
1995
■ ■ ■ ■ y
···
• · · ·τ
1994
■ ■ ■ ■ y
···
■··■▼
1993 1992
■■■¥
ψ
·■■▼
1991
·
■
·
·
·
■
■
■
·
■■Ψ
·
1990 25
35
45
55
65
1
1
1
1
1
25
35
45
55
65
1 25
Age in years
y 1 35
■ '
■
1 45
■
■
·
·
·
1
55
1
25
35
1
1
1
45
55
65
S48
·
2000
ATLAS
OF
ESRD
IN
THE
UNITED
STATES
Table 1.7 Primary disease demographics
column percent, incident patients, 1994-1998 combined Patients with race designated as "other"or"unknown"are included in the total counts.
%
%
Total
%of
Median
pts.
total
age
All ESRD (reference)
382,490
100.0
Diabetes
150,978
39.5
63 64
100 1.6
100 40.9
34,997
9.1
57
30.5
8,490
2.2
47
14,429 96,268
3.8 25.2
66 70
9.8 6.7 5.1
2.8
52
24.9
Neoplasms/tumors
10,801 6,498
17.0 3.4
1.7
69
0.6
1.2
Miscellaneous conditions
12,299
3.2
56
4.5
3.7
DIALYSIS
Glomerulonephritis Secondary GN/vasculitis Interstitial neph/pyeloneph. HTN/large vessel disease Cystic/hereditary/congenital
<20 20-64
%
>64
%
Male
%
Female
%
White
% % Nat.
%
Black
Amer.
Asian
%
Hisp.
100
100
100
100
100
100
35.3
44.1
39.8
37.9
100 62.4
100 42.2
58.8
10.2
39.0 7.4
9.9
7.2
7.9
14.8
1.2
10.4 1.4
7.7
3.0
3.2
2.2
2.3
2.1
2.2
9.1 2.4
3.2
4.3 34.5
4.0 26.9
3.5 23.3
4.7 23.7
2.1 30.4
2.0 11.5
3.2 21.8
16.2
1.6 2.3
3.0
2.6 1.4
3.6
1.4
1.5
2.1
2.6
2.0
2.1
1.1
3.9
2.4
3.0
4.1
1.0 1.4
0.8 1.1
2.0
3.9
3.2
4.0
2.8
2.4
4.1
3.5
9.2
8.6
6.9
10.7
8.0
7.7
1.8
2.7
1.0
Etiology uncertain
13,712
3.6
68
7.0
2.8
2.6 4.4
Missing
34,018
8.9
51
9.2
14.6
2.7
All ESRD (reference)
8,117
100.0
40
100
100
100
100
100
100
100
100
1,310 1,134
16.1
42
0.2
16.3
18.4
19.4
6.7
39
14.1
14.9
9.9
19.4
20.6
2.2
2.1
1.1
1.2
4.8
2.4
5.5
4.5 4.2
3.9 4.6
3.9 4.2
5.2 4.2
2.0 6.2
1.2
5.5
31.5
10.9
6.2 10.5 8.4
6.5
46 39
6.9 0.7
2.3 5.3 3.7
1.8
362 340 1124
30 34
13.8 3.4
15.0 27.4
176
9.3 3.1
9.1 12.7
16.0
14.0
19.3 14.9
100 11.4
100
Diabetes
15.1
12.1
16.2
7.8
8.1 8.1
2.8 6.7
8.8 17.9
TRANSPLANT
Glomerulonephritis Secondary GN/vasculitis Interstitial neph./pyeloneph. HTN/large vessel disease Cystic/hereditary/congenital
17
13.8 0.2
50
0.3
0.2
0.2
0.2
0.2
0.2
0.0
0.0
0.0
Miscellaneous conditions
197
2.4
41
4.0
2.2
1.5
2.3
2.6
2.7
1.9
3.2
1.6
4.7
Etiology uncertain
229
2.8
40
2.9
2.8
0.0
2.0
6.6
4C
2.5 48.C
3.1
39.8
3.0 39.0
2.6
3,228
2.0 41.9
40.3
39.C
33.6
55.9
30.6
56.C
8.8
Total
%of
Median
pts.
total
age
382,490
100.0 39.5
63 64
Neoplasms/tumors
Missing
Table 1.8 Primary disease demographics
row percent, incident patients, 1994-1998 combined Patients with race designated as "other"or"unknown"are included in the total counts.
DIALYSIS All ESRD (reference) Diabetes Glomerulonephritis Secondary GN/vasculitis Interstitial neph./pyeloneph. HTN/large vessel disease Cystic/hereditary/congenital Neoplasms/tumors Miscellaneous conditions Etiology uncertain Missing
150,978 34,997
%
%
<20 20-64
%
>64
%
%
%
% % Nat.
Male
Female
White
Black
%
%
Amer.
Asian
Hisp.
1.3
51.3
47.5
52.9
47.1
1.5
53.1 57.4
46.9 38.4
47.4
52.6
61.5 62.1
30.7
0.1
29.5
2.4
3.3 3.6
9.2 13.7
60.4
39.6
66.2
24.3
1.3
5.4
68.3
26.1
33.2
66.8
31.5
1.4
3.3
9.1 9.7
43.9
53.9
56.4
43.6
61.3 77.4
43.5
0.7
26.5
55.9
44.1
57.8 79.3
2.8 2.9
6.5
56.5
17.0 37.1
0.8
65.1
14.8
0.8
2.5
8.3
9.1
57
2.2
47
4.3 5.7
14,429
3.8
96,268 10,801
25.2
66 70
2.3 0.3
2.8 1.7
52
11.3
34.6 62.2
69
0.5
34.9
64.6
61.6
38.4
76.9
19.6
0.8
1.6
5.1
3.2
56 68
1.8 2.5
59.6
38.6
64.3
35.7
39.4
0.7
1.2
5.8
58.0
3.8
8.9
45.3
47.9
23.6 37.1
1.0
1.3
57.3 54.7
42.7
51
39.5 84.2
56.8 68.9
1.3
2.9
1.9
8,490
6,498 .12,299 13,712 34,018
3.6 8.9
14.5
5.9
TRANSPLANT All ESRD (reference)
8,117
14.9
81.7
3.4
0.8
3.1
3.4
0.2
97.9
1.9
42.9
72.5 82.4
20.6
42
57.5 57.1
42.5
1,310
100.0 16.1
40
Diabetes
14.6
0.9
1.3
3.1
Glomerulonephritis
1,134
14.0
39
10.0
86.9
3.1
58.0
42.0
77.4
14.6
1.1
4.6
6.6
Secondary GN/vasculitis Interstitial neph./pyeloneph.
176 362
2.2
30
21.0
1.7
33.0
17.0
1.7
3.4
34
4.7
50.0
85.9
9.1
1.1
0.8
8.5 4.1
HTN/large vessel disease
340
4.2
46
22.9 2.6
67.0 50.0
76.1
4.5
77.3 72.4
8.5
57.6
42.4
30.3
1.5
2.1
7.1
1124
13.8
39
33.9
2.0
62.7
37.3
63.2 84.7
11.7
0.4
1.5
4.4
70.6
0.0
Cystic/hereditary/congenital Neoplasms/tumors Miscellaneous conditions Etiology uncertain Missing
88.8 64.1
17
0.2
50 41
73.6
2.0
58.8 54.8
41.2 45.2
79.2
23.5 15.7
0.0
2.4
23.5 24.4
76.5
197
1.0
0.0 2.0
229
2.8
40
10.5
86.5
3.1
53.3
46.7
73.4
20.5
0.0
2.2
7.9
3,228
39.8
40
15.7
80.2
4.1
58.3
41.7
61.2
28.9
0.6
4.4
0.7
6.6
CHAPTER
Total
%of
patients
%
i
·
INCIDENCE
%
%
%
PREVALENCE
%
·
S49
Table 1.9
1
3,376
4.0
257
64
38.3
81.8
15.0
1.5
0.2
3.5
Patient demographics by ESRD network incident dialysis patients, 1998
2
6,058
7.2
62
37.6
57.3
2,952
3.5
63
41.5
58.5
4
4,411
5.3
63
39.9
3.6 2.4 0.8
7.8 7.9 1.4
Patients with race designated as "other"or"unknown"are included in the total counts.
5
5,229
6.3
376
61
50.2
1.5
0.2
1.3
6
6,799
8.1
367
59
39.2 41.1
72.9 46.7
33.6 34.9 24.9
0.4
3
338 371 354
57.6
0.8
0.7
Network
Mean
total
Rate per million
age
Diabetes
White
Black
%Nat.
&
Amer.
Asian
Hispanic
0.1 0.2
7
5,038
6.0
348
63
35.7
40.2 67.7
30.0
0.6 1.1
0.2
9.4
8
4,399
5.3
358
60
39.4
46.9
51.9
0.5
0.4
0.1
9
6,510
315
73.4
25.1
0.4
0.2
1.1
3,891
37.0
60.2
36.1
1.6
0.2
5.8
11
5,632
6.7
330 279
62 62
43.0
10
7.8 4.7
62
41.6
1.3
4.2
286
62
41.3
22.3
0.7
2.9 0.7
2.2
3,520
71.1 75.1
23.9
12 13 14
3,795
4.5
376
60
43.5
48.4
46.3
0.5
4.1
0.9
6,192
7.4
59
5.7
4.3
60
77.0
24.2 7.9
3.4
3,611
47.2 47.7
64.1
15
324 257
2.5
16
2,123
188
60
40.0
80.9
8.5
6.1
17
3,922 6,154
2.5 4.7
10.2 3.7
35.3 18.4
301
61
55.1
15.8
25.2
68.3
17.2
62.5
30.6
11.0 3.4
18 All
Network 1
62
83,612
100.0
308 311
44.9 44.2
61
41.4
Total
%of
Rate per
Mean
patients
total
million
age
Diabetes
9,229
689
63
34.1
969
60
984
7.4
%
%
%
% Nat.
White 77.6
Black 19.0
Amer.
32.7
50.0
41.7
61
35.4
52.9
2.2
4.2 14.4
1.2 0.5
25.7
1.6
8.5
%
% Hispanic
3.5
Asian 0.3 0.7
41.5
2.4
0.2
8.2
1.7
4.1
2
17,597
4.0 7.7
3
7,954
3.5
4
11,705
5.1
918
62
34.4
62.3
35.5
0.9
0.2
1.8
5 6
14,807
6.4
1,041
59
33.4
36.6
1.7
21,743
9.5
1,152
58
35.0
29.1
60.4 67.1
0.3 2.1
2.5
1.2
8.6
7
12,863
5.6
869
61
32.6
56.6
41.0
1.2
0.3
8.7
13,758
6.0
1,102
59
34.3
35.8
63.1
0.5
0.4
0.2
9
16,567
7.2
789
61
37.1
64.3
34.1
0.6
0.2
10 11
10,232
4.5
851
61
32.7
52.5
43.7
2.1
1.0 5.4
14,875
6.5
705
61
36.9
63.6
31.5
1.5
0.3 2.9
12
9,093
4.0
724
37.0
67.9
28.7
13
10,461
4.5
1,023
61 59
36.9
40.3
54.2
0.9 0.7
14
18,607
8.1
951
58
43.1
61.2
31.6
15
9,416
4.1
647
59
46.0
71.4
9.2
2.2 2.4
16 17
5,851
2.5
503
59
36.8
78.3
10.0
10,224
4.4
768
60
40.2
49.1 63.1 54.1
18
14,936
6.5
736
60
40.1
All
229,918
100.0
855
60
36.5
Total
%of
Rate per
Mean
%
%
2.3 2.6
4.2
1.2
2.2
32.1
15.0 4.1
20.5
6.8
18.1
28.0
1.2
14.9
19.2
12.3
0.8
27.7
38.8
3.6
1.8
8.6
%
%Nat.
%
4.8
%
patients
total
million
Amer.
Asian
Hispanic
5.0
325
Diabetes 18.7
Black
4,357
age 47
White
1
85.7
10.6
2
5,286
6.1
291
45
15.2
72.8
19.4
2.0 4.4
0.6 0.9
2.8 7.6
Network
3
2,255
2.6
279
46
18.8
70.7
23.0
4.1
0.3
8.5
4
4,900
5.6
384
47
19.6
78.0
19.3
1.7
0.3
1.6
5
4,309
4.9
303
46
17.5
60.8
34.7
3.0
0.5
1.2
6
5,503
6.3
292
45
18.0
60.9
35.4
2.1
1.1
2.0
7
4,177
4.8
282
47
17.7
75.2
21.7
2.3
0.4
7.7
8
4,197
4.8
336
44
15.6
66.0
32.5
0.9
0.2
0.3
9
7,250 4,284
8.3
345
46
19.4
79.7
18.3
1.3
0.3
0.6
4.9 10.7
356
45
19.9
72.7
22.5
2.7
0.6
5.7
440
46
27.0
83.8
12.1
1.6
1.2
45 45
23.0
83.8
13.2
20.4
66.5
28.6
1.6 1.4
1.8 1.0 2.9
1.4
10 11 12
9,289 4,457
13
3,084
3.5
355 302
14
5,947
6.8
304
45
19.7
76.0
18.4
2.6
0.5
19.7
15 16
4,571
5.2
314
45
84.4
5.6
2.8
312
46
86.4
4.7
5.5
17
4,077
4.2 4.7
5.2 2.7
10.6
3,630
26.0 24.5
306
46
18.2
64.5
9.8
20.0
273 324
46
17.6
73.9
11.2
11.2
1.3 1.1
11.6 21.4
46
20.1
75.3
18.5
3.7
1.2
6.0
5.1
18
5,547
6.4
All
87,120
100.0
Patients with race designated as "other"or"unknown"are included in the total counts.
1.1
8
1.3
Table 1.10 Patient demographics by ESRD network prevalent dialysis patients, 1998
1.4
3.0
Table 1.11 Patient demographics by ESRD network prevalent transplant patients, 1998 Patients with race designated as "other"or"unknown"are included in these totals.
S50
·
2 0 0 0
A T L A S
OF
E S R D
IN
HE
Whites, 1990
U N I T E D
S T A T E S
Blacks, 1990
■ 530 to 710 ■ 480 to 530 below 480 Whites, 1998
M 530 to 710 ■ 480 to 530 below 480 Whites, percent change 1990-1998
Blacks, percent change 1990-1998
■ 58 to 66 49 to 58 ■ below 49 Figure 1.17 Prevalent rates by race per million population, point prevalent patients on December 31'' of each year, by HSA, adjusted for age & gender Maps are smoothed using the Bayesian model; see Appendix A for a description of methods.
■ 44 to 53 37 to 44 m below 37
CHAPTER
Ages 20-44,1990
i
·
INCIDENCE
Ages 20-44,1998
■ 1,040 to 1,130 ■ 860 to 1,040 H 820 to 860 ■ below 820 Ages 45-64,1990
& PREVALENCE
Ages 20-44, percent change 1990-1998
■ 1,040 to 1,130 ■ 860 to 1,040 Β 820 to 860 ■ ■ : below 820 Ages 45-64,1998
■ 2,470 to 2,810 ■ 1,740 to 2,470 ■ 1,600 to 1,740 below 1,600 Ages 65-74,1990
■ 2,470 to 2310 ■ 1,740 to 2,470 ■ 1,600 to 1,740 below 1,600 Ages 64-74,1998
3560 H ■ 3,030 to 3,560 U 1,930 to 3,030 ■ 1,650 to 1,930 below 1,650
■ 3,030 to 3,560 ■ 1,930 to 3,030 ■ 1,650 to 1,930 : below 1,650 Ages 75+, 1990
Ages 65-74, percent change 1990-1998
Ages 75+, 1998
■ ■ ■ ■
2360 + 2260 to 2,860 1330 to 2,260 1,070 to 1,330 below 1,070
Figure 1.18 Prevalent rates by age per million population, point prevalent patients on December 3Γ' of each year, by HSA, adjusted for gender & race Maps are smoothed using the Bayesian model; see Appendix A for a description of methods.
Ages 75+, percent change 1990-1998
■ ■ ■ • ■:
2360 H 2260 to 2360 1330 to 2,260 1,070 to 1,330 below 1,070
· S51
S52
■ 2000
ATLAS
OF
ESRD
IN
THE
UNITED
STATES
Figure 1.19 Prior ESRD time prevalent patients
0to6 months
6to<12 months
1to<2 years
2to<4 years
4to<6 years
10+years
6to<10 years
Figure 1.20 Percent of patients with 0-6 months of prior ESRD time prevalent ESRD patients, 1998, by HSA, unadjusted The distribution of patients by vintage, or prior ESRD time, is determined bythe combination of incident rates and length of survival.
■ ■ ■ ■
Figure 1.21 Percent of patients with 6-12 months of prior ESRD time prevalent ESRD patients, 1998, by HSA, unadjusted
3.0 + 2.6 to 3.0 2.2 to 2.6 1.6 to 2.2 below 1.6
CHAPTER
i
·
INCIDENCE
&
PREVALENCE
·
S53
Figure 1.22 Percent of patients with 1 - 2 years of prior ESRD time
prevalent ESRD patients, 1998, byHSA, unadjusted
■ ■ ■ ■
21.8 + 21.0 to 21.8 20.2 to 21.0 19.1 to 20.2 below 19.1
Figure 1.23 Percent of patients with 2-4 years of prior ESRD time
prevalent ESRD patients, 1998, byHSA, unadjusted
Figure 1.24 Percent of patients with 4-6 years of prior ESRD time
prevalent ESRD patients, 1998, by HSA, unadjusted
■ 17.2 + ■ 16.5 to 172 5.8 to 165 14.6 to 15B below 14.6
S 54
·
2000
ATLAS
Figure 1.25 Percent of patients with 6-10 years of prior ESRD time prevalent ESRD patients, 1998, by HSA, unadjusted
Figure 1.26 Percent of patients with greater than 10 years of prior ESRD time prevalent ESRD patients, 1998, by HSA, unadjusted
OF
ESRD
IN
THE
UNITED
STATES