Low employment and low willingness of being reemployed in Chinese working-age maintained hemodialysis patients

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Abstract

Aim: Returning to society plays an important role in improving the quality of life in maintenance hemodialysis (MHD) patients, and retention of employment is one of the core enablers. The study is to assess the employment status and to determine the variables for unemployment in Chinese MHD patients.

Methods: Prevalent MHD patients from four dialysis centers in Shanghai China were enrolled. We assessed patients’ employment status, current social functioning, hemodialysis modality, annual income and general health condition. Among current unemployed working-age patients, the reasons of quitting jobs and willingness of being reemployed were evaluated.

Results: A total of 231 patients were studied, among which 114 patients were unemployed 1 year before hemodialysis. Among 117 employed patients, 16 patients quitted jobs before dialysis inception, while 49 patients quitted jobs at the initiation of HD, and 26 patients followed after a few months’ HD. The main reasons for ceasing employment were physical insufficiency, conflict between dialysis and work schedules, lack of support from employers and resistance from family members. Among the 166 patients who were in their working age, 26 patients were employed. The unemployed patients had the characters of elder age, lower education level, higher annual family income, higher female ratio, lower blood flow, lower physical functioning, and social functioning and lower frequency of weekend hemodialysis and HDF/HF. Among the 140 unemployed patients, only 47 patients had the willingness of being reemployed. Their unemployment status was positively associated with elder age ((OR) 3.13, 95% CI, 1.08–9.1), lower education level ((OR) 1.97, 95% CI, 1.05–5.92), and higher family income ((OR) 7.75, 95% CI, 2.49–24.14).

Conclusion: Ratio of employment and willingness of being reemployed was low in MHD working-age patients. Lack of social and family’s support also hampered patient’s returning to society except for the HD treatment quality.

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Most cited references 22

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The associations of social support and other psychosocial factors with mortality and quality of life in the dialysis outcomes and practice patterns study.

Aurélie Untas, Jyothi Thumma, Nicole Rascle … (2011)

This study aimed to investigate the influence of social support and other psychosocial factors on mortality, adherence to medical care recommendations, and physical quality of life among hemodialysis patients. Data on 32,332 hemodialysis patients enrolled in the Dialysis Outcomes and Practice Patterns Study (1996 to 2008) in 12 countries were analyzed. Social support and other psychosocial factors related to ESRD and its treatment were measured by patient self-reports of health interference with social activities, isolation, feeling like a burden, and support from family and dialysis staff. Cox regression and logistic regression were used to examine associations of baseline social support and other psychosocial factors with all-cause mortality and with other measured outcomes at baseline, adjusting for potential confounders. Mortality was higher among patients reporting that their health interfered with social activities, were isolated, felt like a burden, and were dissatisfied with family support. Poorer family support and several psychosocial measures also were associated with lower adherence to the prescribed hemodialysis length and the recommended weight gain between sessions. Some international differences were observed. Poorer self-reported social support and other psychosocial factors were associated with poor physical quality of life. Poorer social support and other psychosocial factors are associated with higher mortality risk, lower adherence to medical care, and poorer physical quality of life in hemodialysis patients. More research is needed to assess whether interventions to improve social support and other psychosocial factors will lengthen survival and enhance quality of life.

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Geography matters: relationships among urban residential segregation, dialysis facilities, and patient outcomes.

Saunak Sen, Ismael Rodriguez, Ann O’Hare … (2007)

End-stage renal disease disproportionately affects black Americans. However, the impact of residential segregation by race-a prominent feature of many U.S. cities--on outcomes of patients receiving dialysis and on facility performance has not been evaluated. To examine the relationship among racial composition of ZIP codes in metropolitan areas, outcomes of patients receiving dialysis, and characteristics of dialysis facilities. Retrospective cohort study of patients receiving dialysis and cross-sectional study of dialysis facilities. U.S. metropolitan ZIP codes with differing percentages of black residents. Black and non-Hispanic white patients who initiated long-term dialysis between 1 January 1995 and 31 December 2002 (n = 399,424) and dialysis facilities in operation in December 2004 (n = 3244). Mortality and time to transplantation among patients receiving dialysis, and performance of dialysis facilities on the basis of quality indicators (anemia management, dialysis adequacy, and facility-level mortality rates). Most black patients (50.3%) but few white patients (5%) lived in the 3% (n = 769) of ZIP codes in which most residents were black. In analyses adjusted for patient and ZIP code characteristics, mortality rates were higher among white patients but not among black patients living in areas with a higher percentage of black residents (adjusted hazard ratio for ZIP codes with > or =75% black residents vs. or =75% black residents vs. <10% black residents, 0.84 [CI, 0.78 to 0.92] and 0.63 [CI, 0.57 to 0.71] for black patients and white patients, respectively). Dialysis facilities located in areas with a higher percentage of black residents were more likely to have higher-than-expected mortality rates and were less likely to meet performance targets. Patient-level analyses were restricted to black and non-Hispanic white patients. Patient-level and facility-level analyses focused only on the percentage of black residents in each ZIP code. The racial composition of urban residential areas is associated with time to transplantation and dialysis facility performance on standard quality measures. Closer scrutiny of care provided to patients receiving dialysis who live in predominantly black residential areas and to dialysis facilities operating in these areas may be warranted.

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Peritoneal dialysis in China: meeting the challenge of chronic kidney failure.

Xueqing Yu, Xiao-Bao Yang (2015)

Due to limited medical and economic resources, particularly in the countryside and remote areas, the proportion of individuals with end-stage kidney disease who are treated with dialysis in China is only about 20%. For the rest, renal replacement therapy currently is not available. Peritoneal dialysis (PD) has been developed and used for more than 30 years in China to treat patients with end-stage kidney disease. Several national PD centers of first-rate scale and quality have sprung up, but the development of PD varies widely among geographic regions across China. The Chinese government has dedicated itself to continually increasing the coverage and level of medical service for patients with end-stage kidney disease. Under the guidance of the government and because of promotion by kidney care professionals, presently there are more than 40,000 prevalent PD patients in China, representing approximately 20% of the total dialysis population. Recently, a National Dialysis Unit Training Program for countywide hospitals has been initiated. Through the efforts of programs like this, we believe that awareness of PD and advances in the underlying technology will benefit more patients with end-stage kidney disease in China.

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Author and article information

Journal

Journal ID (nlm-ta): Ren Fail

Journal ID (iso-abbrev): Ren Fail

Journal ID (publisher-id): IRNF

Journal ID (publisher-id): irnf20

Title: Renal Failure

Publisher: Taylor & Francis

ISSN (Print): 0886-022X

ISSN (Electronic): 1525-6049

Publication date Collection: 2017

Publication date (Electronic): 14 August 2017

Volume: 39

Issue: 1

Pages: 607-612

Affiliations

[a ]Department of Nursing, Huashan Hospital Fudan University , Shanghai, China;

[b ]Department of Nursing, Pudong Hospital, Fudan University , Shanghai, China;

[c ]Department of Nursing, Shanghai Fifth Hospital, Fudan University , Shanghai, China;

[d ]Department of Nursing, The 455th Hospital of PLA , Shanghai, China;

[e ]Department of Cardiology, Huashan Hospital Fudan University , Shanghai, China;

[f ]Department of Nephrology, Huashan Hospital Fudan University , Shanghai, China

Author notes

[*]

These authors contributed equally to this work.

CONTACT Ping Yan yan_ping98@ 123456126.com Department of Cardiology, Huashan Hospital Fudan University , Shanghai200040, China

Yanpei Cao yanpeicao@ 123456fudan.edu.cn Department of Nursing, Huashan Hospital Fudan University , Shanghai200040, China

Article

Publisher ID: 1361834

DOI: 10.1080/0886022X.2017.1361834

PMC ID: 6446148

PubMed ID: 28805490

SO-VID: ccd838a4-d287-47cd-8f20-4a8babc5e5e4

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 12 January 2017

Date revision received : 17 April 2017

Date accepted : 25 July 2017

Page count

Pages: 6, Words: 4015

Funding

Funded by: Research Development Program of Shanghai

Award ID: 201540085

Funded by: the Research Development Program of Shanghai,China

Award ID: 201540085

This work was funded in part by the Research Development Program of Shanghai [No. 201540085].

Low employment and low willingness of being reemployed in Chinese working-age maintained hemodialysis patients

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Karger: Nephrology

Most cited references 22

The associations of social support and other psychosocial factors with mortality and quality of life in the dialysis outcomes and practice patterns study.

Geography matters: relationships among urban residential segregation, dialysis facilities, and patient outcomes.

Peritoneal dialysis in China: meeting the challenge of chronic kidney failure.

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