Abstract: Objective   To identify socioeconomic factors affecting the incidence of hemodialysis in mainland China.  Methods  Data on the incidence of hemodialysis and socioeconomic factors from 2011 to 2020 across 31 provinces in mainland China (excluding Hong Kong, Macao, and Taiwan) were collected from the National Medical Services and Quality Safety Reports and China Statistical Yearbooks, both covering the years from 2012 to 2021. The provinces were categorized into three groups based on their 2011 per capita GDP levels: low (<30,000 RMB), medium (＞30,000 and ＜80,000 RMB), and high (≥80,000 RMB). Risk factors influencing hemodialysis incidence were analyzed, and the prevalence rates of CKD in different countries and regions were compared.  Results  Year and per capita GDP group affect hemodialysis incidence. The incidence rates of hemodialysis in the low and medium per capita GDP groups were significantly higher in 2020 compared to 2011 (t=3.736, P=0.002; t=12.898, P＜0.001). The growth rate of hemodialysis incidence over ten years was significantly higher in the low and medium GDP group than in the high GDP group (F=5.573, P=0.009; F=0.733, P=0.024). The ratio of rural to urban population, the number of hospital beds per thousand people, the number of healthcare professionals per thousand people, and per capita income were the independent factors affecting hemodialysis incidence (B=-10.663, 6.619, 4.223 and -21.561 respectively; β=    -0.172, 0.232, 0.225 and -0.348 respectively; P=0.008, 0.002, 0.011 and 0.004 respectively). Compared to the global level, mainland China had a lower prevalence of CKD stages 3～5 (2.21 vs. 8.10 pmp).  Conclusion  With the growth of medical service capabilities that accompanies socioeconomic development, the incidence of hemodialysis increases; however, the growth rate of hemodialysis incidence in areas with high per capita GDP is significantly slower than that in areas with low and medium per capita GDP

Key words: Hemodialysis, Incidence rate, Socioeconomic