Abstract: TH-OR094

Socioeconomic Factors and Racial/Ethnic Disparities in PD Initiation

Session Information

  • Peritoneal Dialysis
    November 02, 2017 | Location: Room 290, Morial Convention Center
    Abstract Time: 05:42 PM - 05:54 PM

Category: Dialysis

  • 608 Peritoneal Dialysis

Authors

  • Shen, Jenny I., LaBiomed at Harbor-UCLA, Torrance, California, United States
  • Wilhalme, Holly, UCLA, Los Angeles, California, United States
  • Vangala, Sitaram, UCLA, Los Angeles, California, United States
  • Saxena, Anjali B., Stanford University / Santa Clara Valley Med Ctr, Los Altos, California, United States
  • Norris, Keith C., UCLA, Los Angeles, California, United States
Background

Peritoneal dialysis (PD) has been underutilized in the US. The discrepancy is most pronounced in black and Hispanic patients who, despite having a higher prevalence of chronic kidney disease than non-Hispanic White and Asian patients, are less likely to use PD. We investigated the association of socioeconomic factors with racial and ethnic disparities in the initiation of dialysis with PD in the US.

Methods

We identified from the USRDS all adult patients who initiated dialysis on Day 1 with either hemodialysis (HD) or PD from 2005-13 and categorized them as either non-Hispanic White, Hispanic White, non-Hispanic Black, or non-Hispanic Asian. We then used logistic regression to estimate the odds ratio (OR) of initiating dialysis with PD vs. HD for each of the minority groups compared to non-Hispanic White patients.

Results

Of 522,767 patients, 55% were non-Hispanic White, 28% black, 13% Hispanic white, and 4% Asian; 8% started dialysis on PD. In unadjusted analyses, Blacks and Hispanics were 30% and 21% less likely and Asians were 32% more likely to start on PD than whites (Table). The gap for Blacks and Hispanics widened and for Asians lessened when adjusted for age, sex, and calendar year of dialysis initiation. However, the disparities narrowed when adjusted for individual and neighborhood level socioeconomic factors.

Conclusion

Black and Hispanic patients are less likely to start on PD than White patients, especially given their age, sex, and era of dialysis initiation. This disparity is reduced, but still statistically significant when adjusted for socioeconomic factors. More research is needed to determine whether these variables are associated with potentially modifiable factors such as physician or patient bias against starting PD in patients of a certain socioeconomic background.

OR (95%CI) of starting dialysis on PD (vs. non-Hispanic Whites)
ModelBlacksHispanic WhitesAsians
unadjusted0.69 (0.68-0.71)0.81 (0.78-0.84)1.32 (1.26-1.38)
1: adjusted for age, sex, calendar year0.56 (0.55-0.58)0.66 (0.64-0.68)1.17 (1.12-1.22)
2: adjusted for 1+comorbidities+labs0.66 (0.64-0.68)0.69 (0.67-0.72)1.01 (0.69-1.05)
3: adjusted for 2+socioeconomic factors*0.76 (0.74-0.79)0.90 (0.87-0.94)1.00 (0.95-1.05)

*SES factors: early referral, insurance, employment, neighborhood poverty, neighborhood education, neighborhood % black/Hispanic, neighborhood linguistic isolation, rural/urban, # of nephrologists & large PD units/population, census division

Funding

  • NIDDK Support