Percentage changes in CKD mortality tend to be worse for women, with some exceptions

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August 23, 2022

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Although percentage changes in age-standardized chronic kidney disease are worse for women in 66% of the countries included in this study, there are exceptions where men experience less favorable change.

“Although the introduction of CKD staging in 2002 has strengthened research, much remains unknown about sex (and gender) differences in CKD epidemiology and outcomes.” Carinna Hockham, Ph.D., of the George Institute for Global Health at Imperial College London, and colleagues wrote. “For example, it is unknown whether changes in age-standardized CKD mortality rates over time, or lack of change, have been the same in women and men.”

Infographic showing the percentage of countries with increasing CKD mortality rates in both sexes between 1980 and 2019.
Between 1980 and 2019, there was no change in overall age-standardized mortality for either sex, with female mortality remaining 30% lower than male mortality. Data was derived from Hockham C, et al. kidney med. 2022;doi:10.1016/j.xkme.2022.100535.

In an observational epidemiological study, researchers used data from the Global Burden of Disease (GBD) study to determine the extent to which sex differences in CKD mortality vary over time. GBD Study investigators collected data on CKD deaths from vital registration, verbal autopsy, and surveillance system data between 1980 and 2017.

Using sex as exposure, the researchers sought to measure CKD-associated mortality rates per 100,000 population.

The researchers compared changes in CKD mortality between sexes globally and for the 50 most populous countries. However, in 2019 alone, the researchers also compared sex differences in age-standardized and age-specific mortality across countries.

The researchers used Poisson regression models to determine whether the relationship between age and overall CKD mortality was affected by gender.

Between 1980 and 2019, there was no change in overall age-standardized mortality for either sex, with female mortality remaining 30% lower than male mortality. In addition, 36% of the countries included in the analysis showed increasing rates of CKD mortality in both sexes. Similarly, changes in CKD mortality rates were worse for women in 66% of countries, with the largest disparities in change occurring in Egypt, Thailand and Malaysia.

The largest overall percentage increase occurred in Mexico, with a smaller change for women (81% vs. 138%). Female mortality ranged from 47% lower to 60% higher than male mortality, in Angola and Egypt, respectively.

“Although female mortality was lower than male mortality in most countries in 2019, three of the five countries with the highest CKD-associated mortality rate had higher female rates (Saudi Arabia, Afghanistan and Egypt) . These findings reiterate the need for country-level assessments of sex differences in CKD burden and outcomes to ensure that locally relevant gender-responsive approaches to CKD prevention and care can be developed,” Hockham wrote. and his colleagues.

They added: “In addition, we have only been able to examine sex differences in mortality for CKD across all stages. However, there is some evidence that sex differences are diminished or reversed in patients with more advanced stages, particularly those receiving renal replacement therapy. Mortality is also only one measure of disease burden; A global assessment of sex differences in disability-adjusted life years is also warranted to understand whether women live longer with the condition.”

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