Insights into Geographic Patterns, Urban-Rural Contrasts, and Health Care Disparities in Glomerular Disease Incidence in a Canadian Province
Notice bibliographique
Résumé
Rationale & Objective Glomerular diseases (GDs) are a group of immune-mediated or genetic diseases that involve the filtering units of the kidneys, or glomeruli. Using centralized provincial kidney pathology records and census data, we aimed to examine the incidence and temporal trend of GDs in Saskatchewan, Canada and understand rural/urban differences in GD distribution. Study Design Population-based epidemiologic study. Setting & Participants All adult patients who underwent kidney biopsies in Saskatchewan, Canada, from 2002-2018. Exposures or Predictors Biopsy diagnosis, 3-digit postal codes, laboratory parameters, dialysis initiation dates, and mortality data. Outcomes Incidence of primary GD, dialysis initiation, and all-cause mortality. Analytical Approach Regional variations in GD were analyzed using SaTScan v10.1.3 software. Incidence trends, rural/urban differences, and geospatial clustering were evaluated. Ethics approval was obtained from the provincial research and ethics board. Results A total of 1,372 of 3,509 kidney biopsies met the inclusion criteria. GD incidence increased from 4.6 to 13.6 per 100,000 persons from 2002 to 2018 ( P < 0.001). GD incidence was higher in rural areas than in urban areas (10.73 vs 8.92 per 100,000 per year, P < 0.001). Significantly higher dialysis progression rates were seen for rural and remote areas ( P < 0.001). A geospatial cluster of 345.7 km 2 was identified for lupus nephropathy, with an incidence rate ratio of 1.73, a relative risk of 2.7, and a log likelihood ratio of 13.87. Limitations Biopsies were dependent on the threshold of the ordering physician. Likely, frail and elderly patients and patients with early onset glomerulonephritis, late presentations, and higher bleeding risk were not biopsied, which led to an underrepresentation of these groups. Conclusions The incidence and relative burden of GDs have increased over time in Saskatchewan, with notable rural/urban differences. We identified a geographic cluster for lupus nephropathy encompassing rural and urban areas. Patients in rural and remote areas had higher dialysis transition rates, and mortality rates were relatively higher in urban areas. Addressing and understanding the multifaceted factors driving these disparities are essential steps toward easing the burden of GDs on impacted communities. Plain-Language Summary Glomerular diseases are a group of immune-mediated or genetic diseases that involve the glomeruli, the filtering units of the kidneys. We conducted a population-level study based on 1,372 kidney biopsies performed on adults from 2002-2018 in Saskatchewan, Canada. We collected and analyzed data on age, sex, 3-digit postal codes, date of biopsy, glomerular disease diagnosis, dialysis start date, and death. The incidence of glomerular diseases increased from 4.6 to 13.6 per 100,000 persons over the study period, with higher rates in rural areas. Patients in rural and remote areas also had higher rates of dialysis progression, whereas mortality rates were higher in urban areas. A geospatial cluster was identified for lupus nephropathy encompassing both rural and urban areas. This study highlights understanding and addressing the factors behind these differences.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,005 | 0,010 |
| Études des sciences et des technologies | 0,004 | 0,001 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».