Abstract: TH-PO389
Racial and Ethnic Disparities in Treatment Modalities for ESRD Vary by Patient Age
Session Information
- Dialysis: Peritoneal Dialysis - I
October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 703 Dialysis: Peritoneal Dialysis
Authors
- Wilk, Adam S., Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
- Magua, Wairimu, Emory University School of Medicine, Atlanta, Georgia, United States
- Cummings, Janet, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
- Plantinga, Laura, Emory University School of Medicine, Atlanta, Georgia, United States
- Franch, Harold A., Emory Dialysis Centers, Atlanta, Georgia, United States
- Patzer, Rachel E., Emory Transplant Center, Atlanta, Georgia, United States
- Lea, Janice P., Emory Dialysis Centers, Atlanta, Georgia, United States
Background
Black patients present with end-stage renal disease (ESRD) at younger ages than whites, while younger patients are more likely to undergo transplantation (Tx) and to use peritoneal dialysis (PD) or home hemodialysis (HHD) versus in-center hemodialysis (HD). It is unknown whether disparities in treatment modality use across racial/ethnic groups are consistent among all ages.
Methods
We used 2011-2015 USRDS data to identify treatment modalities—Tx, HD, PD, HHD, or Other—at day 90 of therapy (persisting for ≥60 days) for all incident US ESRD patients. We compared use of each modality between racial/ethnic groups (Hispanic, non-Hispanic [NH] Black, NH White, Other) pairwise using t tests, both overall and stratified by age: 22-44, 45-64, 65-74, and 75-99. We computed relative risks (RRs) across groups and tested whether age modified these RRs in multinomial logit models, controlling for patient factors. Missing data, discontinued dialysis/recovered function, and lost follow up (e.g., died before day 90) were excluded.
Results
During 2011-2015, 81.5% of 552,896 patients used HD at day 90, 10.0% used PD, 0.7% used HHD, 2.8% underwent Tx, and 4.9% were classified as Other. NH Blacks and Hispanics were less likely to use PD and Tx and more likely to use HD versus NH Whites (all p<0.01). Tx disparities were greatest among age 22-44 for NH Blacks (RR 0.144) and among age 45-64 for Hispanics (RR 0.318), and were smallest among age 75+ (RRs 0.269 and 0.444, respectively) (all p<0.01; see Table). PD disparities were greatest among age 75+ (RRs 0.476 and 0.625, respectively) and smallest among age 22-44 (RRs 0.691 and 0.825, respectively) (all p<0.01). HHD disparities varied across groups by age. Results were similar in adjusted multinomial logit models.
Conclusion
There are large racial/ethnic disparities in HD, PD, and Tx use by incident ESRD patients. Tx disparities are worse for younger patients, and PD disparities are worse for older patients.
| Age 22-44 (N=63,038) | Age 45-64 (N=219,723) | Age 65-74 (N=139,703) | Age 75-99 (N=130,432) | |||||||||||||
| Modality | HD | HHD | PD | Tx | HD | HHD | PD | Tx | HD | HHD | PD | Tx | HD | HHD | PD | Tx |
| All Patients | 74.6% | 0.7% | 16.8% | 6.2% | 81.0% | 0.7% | 11.4% | 3.7% | 83.2% | 0.7% | 8.7% | 2.1% | 84.2% | 0.7% | 5.9% | 0.2% |
| NH White (ref.) | 65.3% | 1.1% | 19.9% | 11.4% | 75.8% | 1.0% | 13.3% | 5.9% | 80.0% | 0.8% | 10.0% | 2.8% | 82.4% | 0.7% | 6.8% | 0.3% |
| NH Black / NH White (RR) | 1.263 | 0.546 | 0.691 | 0.144 | 1.141 | 0.568 | 0.669 | 0.230 | 1.104 | 0.914 | 0.572 | 0.267 | 1.074 | 1.414 | 0.476 | 0.269 |
| Hispanic / NH White (RR) | 1.191 | 0.418 | 0.825 | 0.366 | 1.131 | 0.385 | 0.748 | 0.318 | 1.104 | 0.534 | 0.647 | 0.372 | 1.062 | 1.176 | 0.625 | 0.444 |
Results do not add to 100%: "other" modalities (e.g., center self-hemodialysis, unknown dialysis) excluded.
Funding
- Other NIH Support