Table 3.
Rates of Death by Health Insurance Status
Stratified by CKD Stage |
CKD Stage |
|||||
---|---|---|---|---|---|---|
Overall | No CKD | 1–2 | 3a | 3b | 4–5 | |
No. of participants | 86,588 | 73,590 | 7,162 | 4,417 | 1,036 | 383 |
No. of events | 1,020 | 625 | 196 | 113 | 54 | 32 |
Person-years | 365,730.34 | 313,589.99 | 30,302.08 | 16,927.09 | 3,569.77 | 1,333.43 |
Rate per 1,000 person-years | 2.79 | 1.99 | 6.47 | 6.68 | 15.13 | 24.00 |
No insurance | 3.17 | 2.32 | 6.78 | 7.37 | 14.25 | 23.62 |
Public insurance | 8.10 | 5.14 | 16.15 | 17.04 | 32.71 | 37.60 |
Private insurance | 1.88 | 1.47 | 4.18 | 4.13 | 8.28 | 18.33 |
HRa (95% CI) unadjusted | ||||||
No insurance vs private | 1.73 (1.50–2.01) | 1.63 (1.36–1.96) | 1.66 (1.19–2.33) | 1.80 (1.12–2.87) | 1.77 (0.84–3.74) | 1.36 (0.57–3.25) |
Public insurance vs private | 4.42 (3.81–5.14) | 3.60 (2.94–4.40) | 3.97 (2.82–5.59) | 4.18 (2.72–6.42) | 4.12 (2.21–7.68) | 2.20 (0.96–5.04) |
HRb (95% CI) adjusted for only demographic variables |
||||||
No insurance vs private | 1.82 (1.56–2.12) | 1.68 (1.39–2.04) | 1.66 (1.18–2.36) | 1.84 (1.13–2.98) | 1.91 (0.89–4.10) | 1.46 (0.59–3.64) |
Public insurance vs private | 3.22 (2.76–3.76) | 2.58 (2.09–3.18) | 3.22 (2.27–4.57) | 3.63 (2.34–5.65) | 3.43 (1.81–6.50) | 1.91 (0.79–4.65) |
HRc,d (95% CI) adjusted for variables potentially in the causal pathway |
||||||
No insurance vs private | 1.65 (1.42–1.93) | 1.65 (1.37–2.00) | 1.59 (1.12–2.25) | 1.55 (0.94–2.57) | 2.10 (0.88–5.05) | — |
Public insurance vs private | 2.40 (2.04–2.82) | 2.30 (1.86–2.84) | 2.74 (1.92–3.91) | 2.35 (1.44–3.85) | 1.87 (0.89–3.96) | — |
HRd (95% CI) adjusted for the above variables + eGFR |
— | |||||
No insurance vs private | 1.66 (1.43–1.94) | 1.65 (1.36–1.99) | 1.60 (1.13–2.26) | 1.56 (0.94–2.57) | 2.07 (0.86–4.97) | — |
Public insurance vs private | 2.37 (2.01–2.78) | 2.30 (1.86–2.84) | 2.73 (1.91–3.90) | 2.33 (1.43–3.81) | 1.89 (0.89–4.01) | — |
Stratified by eGFR | ||||||
eGFR >60 | eGFR = 30–59 (CKD stage 3) | eGFR <30 (CKD stages 4–5) | ||||
HRb (95% CI) adjusted for only demographic variables | ||||||
No insurance vs private | 1.76 (1.49–2.08) | 1.86 (1.24–2.80) | 1.46 (0.59–3.64) | |||
Public insurance vs private |
2.89 (2.42–3.45) | 3.82 (2.66–5.47) | 1.91 (0.79–4.65) |
Abbreviations: CI, confidence interval; CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate (in mL/min/1.73 m2); HR, hazard ratio.
Unadjusted.
Models adjusted for age, sex, race, ethnicity, education, and smoking.
Models adjusted for age, sex, race, ethnicity, education, smoking, hypertension, diabetes, cardiovascular disease, albuminuria, and body mass index.
At CKD stages 4–5, all deaths are in participants with hypertension regardless of whether they had insurance. The HR for hypertension is close to infinity, resulting in an unreliable model.