Chapter 2: Healthy People 2020




In this chapter we examine data for ten Healthy People 2020 (HP2020) Objectives (nine for CKD and one for diabetes), spanning 19 total indicators. As in previous ADRs, we present data overall and stratified by race, sex, and age groups. In 2014, 12 of 19 indicators met HP2020 goals, with most of the remaining objectives continuing to show improvement. We present state-level comparison maps for HP2020 objectives CKD-10 (proportion of ESRD patients receiving care from a nephrologist at least 12 months before the start of renal replacement therapy) and CKD-13.1 (proportion of patients receiving a kidney transplant within three years of end-stage renal disease; Figures 2.1 and 2.2). More than 80% of states achieved the HP2020 target for CKD-10, while just over 20% achieved the target for CKD-13.1. For both these objectives there was significant geographic variation, with percentages varying between states by greater than 50% from the lowest to highest quintiles. For HP2020 objectives relating to vascular access, we present data from CROWNWeb examining HP2020 objectives CKD 11-1 (proportion of adult hemodialysis patients who use arteriovenous fistulas as the primary mode of vascular access) and CKD 11-2 (proportion of adult hemodialysis patients who use catheters as the only mode of vascular access; Tables 2.9 and 2.10). In 2014, we continued to observe an increasing trend in proportion of patients using arteriovenous fistulas, reaching 63.9% overall; notably, this trend was observed across nearly all subgroups. In 2014, we continued to observe a trend towards decreasing all-cause mortality among prevalent dialysis patients. The total death rate fell to 172.8 deaths per 1,000 patient years, a more than 25% decrease from 233.7 deaths per 1,000 patient years seen in 2001.

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