ESRD is a disease that accumulates uremic toxin due to almost no kidney function. ESRD patients will continue to increase exponentially with aging populations and an increase in the incidence of chronic diseases such as diabetes and high blood pressure [5]. ESRD is managed by RRT such as KT or dialysis. So, the patients’ lifespan will be also increased more and more [5]. In Korea, the number of patients receiving RRT increased to 75,042 in 2013 and 80,674 in 2014 [13, 14]. Therefore, the Kidney Disabled who receive KT or dialysis with ESRD will increase further in the future, and the burden of the nation will also increase.
ESRD is a chronic and severe disease that requires long-term care with high-cost medical care such as RRT. ESRD patients are severely limited to full-time activity over a long period of time. As a result, only about 22 percent of HD and 36 percent of PD patients work full-time [5]. Nevertheless, studies on the personal OOP burden and the QOL caused by ESRD are rare, and studies on the health severity of the Kidney Disabled due to ESRD are even very rare. Therefore, this study targeted comparisons of severity between the Kidney Disabled and Non-Kidney Disabled by the number of chronic diseases, annual OOP medical expenditure, and the QOL.
In our research, 28.7% of the Kidney Disabled had MA lower than 35.5% of the Non-Kidney Disabled. The OOP medical expenditure burden in NHI was higher than MA. In addition, the economic activity of the Non-Kidney Disabled was 33.9% while only 12.5% of the Kidney Disabled. It reflected that the latter subjects required a lot of time to treat and had a quite difficult situation to sustain a job. In the previous study, it was similar that only a small percentage had economic activity in ESRD [15–18]. Therefore, it needs to consider the medical welfare policy about OOP expenditure in the Kidney Disabled, especially than others. It needs not the only improvement about the negative perception for the disabled, but also labor policy to ensure livelihood security through national benefit enforcement for the employer to employ the kidney disabled.
Twenty-Five percent of the U.S. adult population had at least 2 chronic diseases, which were the critical etiology of mortality [19]. Patients with ESRD had a larger comorbidity burden [20]. It was similar to our study results. In this study, the number of chronic diseases was 4.7 in the Kidney Disabled and 3.3 of the Non-Kidney Disabled (P<0.001). In addition, trends over five years in the number of chronic diseases between the Kidney Disabled and Non-Kidney Disabled also showed a significant difference (P<0.01).
In other country, Medicare beneficiaries with ESRD would have approximately twice OOP expenditure than that of Medicare in Non-ESRD [21]. In our study, annual OOP medical expenditure was $1,310 in the Kidney Disabled and $832 in the Non-Kidney Disabled (P<0.001). Trend over five years of annual OOP medical expenditure showed a significant difference between the Kidney Disabled and the Non-Kidney Disabled (P<0.001).
In the previous study, the QOL of ESRD was lower than Non-ESRD, especially the QOL in five domains index including Mobility, Usual Activities, and Pain/Discomfort [22]. In this study, today’s subjective health status for QOL points (EQ VAS) showed a significant difference between 48.9 points for the Kidney Disabled and 60.4 points for non-kidney disabled (P<0.001). From 2009 to 2013, five years of data were used to identify trend in QOL through panel analysis. As a result, in all five years, the Kidney Disabled had lower QOL than the non-kidney disabled (p<0.01).
The limitation of our study as follows: First, it did not consider the cost of over-the-count medicine or herb-drug. So, the OOP medical expenditure in this study may be underestimated. Second, since the number of Internal-organ disabled was not large, the Kidney-Disabled and all other Internal-organ disabled were grouped and compared. Therefore, different characteristics of each disability were not considered. Third, the raw material already combined subjects with the KT and dialysis and a small number of KT, so we are not able to analyze the difference between the KT and dialysis. Further research comparing the KT and dialysis will be recommended.
Nonetheless, the strength of this study as follows: First, the financial burden from the OOP medical expenditure was identified in the Kidney Disabled. In most countries, even though the financial burden due to ESRD was a critical issue, there were studies only about health insurance expenditure, but few studies about the OOP medical expenditure. Second, multimorbidity and QOL being the poorest in the Kidney Disabled will provide the evidence for medical policy, and prioritizing for the medical agenda is crucial in the effectiveness. Third, studies on the health level of people with Internal-organ disabled, especially those with Kidney Disabled, are very rare. Therefore, the study could provide key information on the equity of health policies among the disabled.