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PLoS One. 2018 Dec 31;13(12):e0209259. doi: 10.1371/journal.pone.0209259. eCollection 2018.

Facing the urban-rural gap in patients with chronic kidney disease: Evidence from inpatients with urban or rural medical insurance in central China.

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Tongji Medical College, Huazhong University of Science & Technology, Wuhan City, Hubei Province, China.
College of Politics & Law and Public Administration, Hubei University, Wuhan City, Hubei Province, China.
Taihe Hospital of Shiyan City, Shiyan City, Hubei Province, China.



In view of the irreversible pathology of progressive exacerbation, the societal burden of chronic kidney disease (CKD) is increasing along with the rise in total health expenditure. Meanwhile, disparities remain among urban and rural citizens with different types of health insurance. This study aimed to assess the socioeconomic disparities between hospitalized CKD patients in urban and rural areas.


A total of 501 CKD inpatients with urban or rural medical insurance (UMI or RMI, respectively) were selected from the top six tertiary hospitals in Wuhan. Demographic and socioeconomic data were collected as influencing factors. Data evaluation was performed using univariate and multivariate analyses.


Socioeconomic characteristics showed differences among hospitalized CKD patients with different health insurances. Patients with RMI were younger, and reported lower education levels, poor domestic economic conditions, shorter duration, and less frequent hospital stays than those with UMI (P<0.05). The predictors revealed varying associations between UMI and RMI. Among the hospitalized CKD patients with UMI, male and low-education individuals presented high hospitalization expenses (βgender = -0.406, βeducation level = 0.357, P<0.05). By contrast, no significant difference in this aspect was found among RMI inpatients.


Care delivery and reimbursement models should be re-designed and implemented to improve equity among different CKD patients. The national health education should also be enhanced to prevent CKD and provide early treatment.

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