Hospitalization during the first year of chronic dialysis occurs relatively frequently, complicating the coordination of care during an already difficult time for incident patients. Between the beginning of 1996 and the end of 2005, first-year hospital admission rates were unchanged. Subsequently, however, rates began to decline. Among patients in 2006, rates were more than 3 percent lower than among corresponding patients in 2005. Rates continued to fall among successive annual cohorts of incident patients, leading to a cumulative reduction of more than 0.2 admissions per patient year between 2005 and 2010.
Regional variation in rates is apparent, with a difference of more than 0.5 admissions per patient year between the Census Divisions with lowest and highest first-year hospital admission rates among incident dialysis patients in 2010. This variation may indicate important differences in socioeconomic status and access to health care. The southern borders of Illinois, Indiana, and Ohio, for instance, are within the Ohio River basin, an area with high incidence of ESRD, substantial poverty, and historical air and water pollution. From this perspective, the absence of a downward trend in first-year hospitalization in the East North Central Division is concerning.
First-year Hospital Admission Rates Among Incident Dialysis Patients, by Annual, Quarterly, & Monthly Cohorts
First-year Hospital Admission Rates, Overall & by U.S. Census Division
First Year Hospital Admission Rates Among Incident Dialysis Patients
After first Medicare-covered dialysis session in freestanding facility. Admissions per patient year; APC, Annual Percent Change. Maps show 2010 rates.