Abstract: FR-PO915
Racial and Gender Disparities in Long-Term Clinical Outcomes among Elderly Dialysis Patients
Session Information
- Geriatric Nephrology
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Geriatric Nephrology
- 901 Geriatric Nephrology
Authors
- Shah, Silvi, University of Cincinnati, Cincinnati, Ohio, United States
- Leonard, Anthony C., University of Cincinnati, Cincinnati, Ohio, United States
- Thakar, Charuhas V., University of Cincinnati, Cincinnati, Ohio, United States
Background
Mortality in end stage renal disease (ESRD) patients is highest during the first year of dialysis. However, after considering the influence of pre-dialysis health status (defined as nephrology care and acute care hospitalizations) and dialysis access; the effects of race and gender on long-term mortality among incident Medicare dialysis patients are not known.
Methods
We evaluated 49,645 adult incident dialysis patients (1/1/2008 to 12/31/2008) from the United States Renal Data System (USRDS) with linked Medicare data for at least 2 years prior to dialysis initiation. Information on pre-dialysis health status was obtained from form 2728 and linked Medicare claims. Using case-mix adjusted logistic regression models (16 variables), we examined the effect of race and gender on one-year all cause mortality after dialysis initiation.
Results
Mean age of study population was 72±11 years. Of the study cohort, 26% were octogenarian; 55% were male; and 63% were White. Of those who started hemodialysis (HD), 82% initiated with a catheter. One-year mortality was 31%. Pre-dialysis nephrology care was associated with lower mortality in dialysis patients than those without nephrology care (26% vs. 39%, p<0.001). Pre-dialysis acute hospitalization was associated with higher mortality than those without pre-dialysis hospitalization (33% vs. 19%, p<0.001). As compared to patients with catheter, incident AV access was associated with lower mortality (35% vs. 16%; p<0.001). In adjusted analyses, as compared to Whites, one-year mortality was lower among Blacks (odds ratio [OR], 0.7; 95% confidence interval [CI], 0.66-0.74]), Hispanics (OR, 0.65; CI, 0.60-0.70) and Asians (OR, 0.65; CI, 0.57-0.74). Females were less likely to die within one year after initiating dialysis than males (OR, 0.95; CI, 0.91-0.99).
Conclusion
Among elderly dialysis patients; Blacks, Hispanics and Asians have a lower mortality than Whites; and females have lower mortality than males. These differences across race and gender exist independent of pre-dialysis health status and dialysis access type. Biological factors associated with these disparities need to be explored further to understand the reasons behind the survival advantage among minorities and women.