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MORTALITY DUE TO CHRONIC KIDNEY DISEASE (CKD) IS INFLUENCED BY ACCESS TO EARLY DIAGNOSIS, CONTROL OF RISK FACTORS, COMORBIDITIES AND ADEQUATE TREATMENT. UNFAVORABLE SOCIO-ECONOMIC FACTORS AND FRAGMENTATION OF HEALTH SYSTEMS COULD LEAD TO INEQUALITIES IN CARE, GENERATING A GREATER BURDEN OF DISEASE.
ECOLOGICAL STUDY IN THE 24 ARGENTINE PROVINCES ACCORDING TO OFFICIAL MORTALITY DATA DURING THE PERIOD 2019-2021.CAUSES OF MORTALITY DUE TO CKD WERE SELECTED ACCORDING TO ICD10 IN PATIENTS OVER 18 YEARS OF AGE. THE CHRONIC POVERTY (CP) RATE WAS CONSTRUCTED USING VARIOUS INDICATORS FROM THE 2010 CENSUS (LATEST AVAILABLE DATA).CP IS POVERTY IN TERMS OF INCOME, INFRASTRUCTURE AND ACCESS TO BASIC SERVICES (E.G. EDUCATION AND HEALTH). CRUDE MORTALITY RATES (CMR) AND ADJUSTED MORTALITY RATES (AMR) WERE CALCULATED BY DIRECT ADJUST METHOD WITH 95% CI AND A SIGNIFICANCE LEVEL OF 0.05. BETWEEN PROVINCES, THE AMR AND AVERAGE AGE WERE CORRELATED WITH PC. THE ANALYSIS OF INEQUALITIES WAS PERFORMED BY CALCULATING THE ABSOLUTE AND RELATIVE GAP BETWEEN THE PC RATE AND THE AVERAGE AGE, COMPARING THE PROVINCES WITH THE HIGHEST AND LOWEST POVERTY QUINTILES. R STUDIO AND EPIDAT 4.2 WERE USED.
GBMR AND AMR WERE 14.9 (95%CI 14.4-14.9) AND 6.2 (95%CI 6.0-6.4) C/100,000 POPULATION, RESPECTIVELY. A TOTAL OF 54.8% (95%CI 53.9-55.6) OF THE DEATHS OCCURRED IN MALES AND THIS PROPORTION WAS SIMILAR IN ALL PROVINCES.THE MEAN AGE WAS 73.3 YEARS (SD 14.1), BEING LOWER IN MALES (72.4 YEARS SD 13.5) THAN IN FEMALES (74.5 YEARS SD 14.6) (P<0.05).AT THE NATIONAL LEVEL, THE MOST FREQUENT CAUSES WERE UNSPECIFIED CHRONIC RENAL FAILURE (68.9% CI95% 68.2-69.7) AND DIABETES (23.7% CI95% 23.1-24.4).THE HIGHEST AMR FOR CKD WERE OBSERVED IN 3 NORTHERN PROVINCES WITH THE HIGHEST POVERTY QUINTILES (MISIONES, JUJUY AND SALTA) AND IN 2 SOUTHERN PROVINCES (CHUBUT AND NEUQUEN) WITH THE LOWEST QUINTILES. THE LOWEST AMR WERE OBSERVED IN LA PAMPA AND CIUDAD AUTÓNOMA DE BUENOS AIRES (WITH THE LOWEST QUINTILES) AND IN SANTIAGO DEL ESTERO (WITH THE HIGHEST QUINTILE), WITH NO RELATIONSHIP BETWEEN AMR AND PC (P>0.05). THE MEAN AGE OF DEATHS WAS LOWER IN THE POOREST PROVINCES THAN IN THOSE WITH A HIGHER SOCIOECONOMIC LEVEL (P<0.05). IN THE PROVINCES WITH HIGHER PC QUINTILES, PEOPLE DIED AN AVERAGE OF 6 YEARS EARLIER THAN IN THOSE WITH LOWER PC QUINTILES AND THE AMR DUE TO CKD WAS 40% HIGHER THAN IN THE MORE ADVANTAGED PROVINCES.
NOTABLE REGIONAL DISPARITIES WERE IDENTIFIED IN ARGENTINA, WHICH COULD BE LARGELY ATTRIBUTED TO AN UNEQUAL DISTRIBUTION OF RESOURCES AND INEQUITABLE ACCESS TO THE HEALTH SYSTEM. UNDERREPORTING OF DATA IN SOME JURISDICTIONS (LA PAMPA AND SANTIAGO DEL ESTERO) IS NOT RULED OUT.THESE INEQUALITIES SUPPORT THE NEED TO ESTABLISH A NATIONAL RENAL HEALTH PROGRAM TO SYSTEMATIZE INTERVENTIONS IN RELATION TO EARLY DIAGNOSIS, TIMELY TREATMENT, PREVENTION OF COMPLICATIONS AND ADEQUATE ACCESS TO SUBSTITUTIVE TREATMENT, REDUCING INEQUITIES AND GUARANTEEING AN EFFICIENT DISTRIBUTION OF RESOURCES.THIS REQUIRES ARTICULATION BETWEEN THE DIFFERENT JURISDICTIONS, AS WELL AS ALLIANCES AND JOINT ACTIONS BETWEEN CENTERS WITH GREATER EXPERIENCE AND RESOURCES TO DEVELOP AND STRENGTHEN CAPACITIES WHERE THEY ARE MOST NEEDED.