Chronic kidney disease mortality in Costa Rica ; geographical distribution, spatial analysis and non-traditional risk factors

Sammanfattning: Central America in general and Costa Rica in particular have been facing with increasing number of Chronic Kidney Disease (CKD). Experts have recently (2013) recommended spatial analysis of the relevant data for better understanding of the situation. This study was performed to evaluate geographical distribution of CKD mortality in Costa Rica through spatial analysis of CKD mortality data. The study also looked at associations between CKD mortality and environmental factors. Moreover, this thesis evaluated physicians’ knowledge about non-traditional factors affecting CKD. CKD mortality data (1980 - 2012) were statistically and spatially analysed. Over the study period, CKD mortality showed an upward trend and geographically progressed to the neighbouring areas. Northern parts of the country were identified as the hot spot. Significant associations between CKD mortality and temperature, permanent crops and precipitation were observed (p< 0.05). There were inconsistencies in the effect of temperature and precipitation in different parts of the country. The study also showed an inadequate knowledge of physicians on the possible environmental risk factors for CKD. The findings of this study provided objective evidence on the progressive nature of the CKD problem in Costa Rica. This study also provided further evidence in support of the newly emerging non-traditional risk factors for CKD (agricultural occupation, heat stress etc.). Further investigations are recommended.