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Kidney Week

Abstract: SA-PO1064

Geographic Variation of Increasing Mortality Risk in Black Dialysis Patients with Medicare Fee-for-Service Coverage

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Weinhandl, Eric D., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Ray, Debabrata, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Kubisiak, Kristine, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Collins, Allan J., Fresenius Medical Care North America, Waltham, Massachusetts, United States
Background

We recently reported that the weekly risk of death in black dialysis patients with Medicare fee-for-service coverage increased between 2014 and 2017, from 25.2 deaths per 10,000 patients per week to 27.1 deaths per 10,000 patients per week (Am J Nephrol, 2019). We aimed to assess whether this increase was homogeneous across US Census Divisions.

Methods

Using Medicare Limited Data Sets, we identified all black patients with Medicare Part B claims documenting outpatient dialysis from January 2014 to December 2017. For each calendar week (Monday to Sunday), we identified patients who had at least one outpatient dialysis session and who were alive at the end of the week; we calculated the proportion of patients who died during the subsequent calendar week. From the time series of weekly death rates in each US Census Division, we fit an autoregressive integrated moving average model to assess secular trend.

Results

The cohort included 208,768 unique patients; 23,685,808 patient-weeks; and 62,200 deaths. Mean age was 59.2 ± 14.0 years, 53% were female, and 54% of patients were concurrently enrolled in Medicare and Medicaid. Weekly mortality rates among all black patients were 25.1, 26.3, 26.5, and 27.1 deaths per 10,000 patients per week in 2014, 2015, 2016, and 2017, respectively. Death rates per 10,000 patients per week, by Census Division, are displayed in the table. Weekly mortality rates increased both monotonically and significantly (P < 0.05) in the South Atlantic and East South Central regions, an area that stretches from the Mississippi and Ohio Rivers to the Atlantic Ocean.

Conclusion

Increasing mortality among black dialysis patients with Medicare fee-for-service coverage appears to be a unique feature of the southeastern part of the United States. The extent to which this trend reflects dialytic factors versus broader health and socioeconomic trends is unclear, but merits detailed investigation.