Mortality in Patients With Chronic Renal Disease Without Health Insurance in Mexico: Opportunities for a National Renal Health Policy

Abstract

IntroductionDespite a systematic increase in the coverage of patients with end-stage renal disease (ESRD) who have received dialytic therapies and transplantation over the past 2 decades, the Mexican health system currently still does not have a program to provide full coverage of ESRD. Our aim was to analyze mortality in patients with ESRD without health insurance.MethodsThis was a prospective cohort study of 850 patients with advanced chronic kidney disease (CKD). Risk factors associated with death were calculated using a Cox's proportional hazards model. We used the statistical package SPSS version 22.0 for data analysis.ResultsThe mean age of patients was 44.8 ± 17.2 years old. At the time of hospital admission, 87.6% of the population did not have a social security program to cover the cost of renal replacement treatment, and 91.3% of families had an income below US$300 per month. During the 3 years of the study, 28.8% of the cohort patients were enrolled in 1 of Mexico's social security programs. The 3-year mortality rate was of 56.7% among patients without access to health insurance, in contrast to 38.2% of patients who had access to a social security program that provided access to renal replacement therapy (P < 0.001). Risk factor analysis revealed that not having health insurance increased mortality (risk ratio: 2.64, 95% confidence intervals: 1.84−3.79; P = 0.001).ConclusionMexico needs a coordinated National Kidney Health and Treatment Program. A program of this nature should provide the basis for an appropriate educational and intervention strategy for early detection, prevention, and treatment of patients with advanced chronic kidney disease.

Overview of the burden of chronic kidney disease in Mexico: secondary data analysis based on the Global Burden of Disease Study 2017

“…25 One recent study reported that the 3-year mortality rate of CKD patients requiring RRT in Mexico who did not have social security was 56.7%. 48 Those patients who did have a health service providing RRT showed a 3-year mortality rate of 38.2%. 48 Thus, patients without health insurance were 2.64 times more likely to die from CKD than those who did.…”

“…48 Those patients who did have a health service providing RRT showed a 3-year mortality rate of 38.2%. 48 Thus, patients without health insurance were 2.64 times more likely to die from CKD than those who did. 48 Therefore, socioeconomically disadvantaged…”

“…48 Thus, patients without health insurance were 2.64 times more likely to die from CKD than those who did. 48 Therefore, socioeconomically disadvantaged…”

Global Dialysis Perspective: Mexico

“…Also, mortality rate was higher in patients without health insurance than patients with health insurance (56.6% vs 38.2%). This alarming data reflects the fact that uninsured patients with intermittent modalities and poor economic conditions experience the worst outcomes 16 .…”

The Tragedy of Having ESRD in Mexico

“…Thirteen years after our first report that highlighted the disparities of access to renal replacement therapy (RRT) in the Mexican population, 1 the study by Valdez-Ortiz et al. 2 indicates that nothing has changed to improve access and quality of care to end-stage renal disease (ESRD) patients in Mexico.…”