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Abstract: FR-PO895

Disparities in ESRD and Mortality Among Older and Younger Black and Hispanic Patients in the United States

Session Information

Category: Diversity and Equity in Kidney Health

  • 800 Diversity and Equity in Kidney Health

Authors

  • Liu, Jiannong, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Guo, Haifeng, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Wetmore, James B., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Gilbertson, David T., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Johansen, Kirsten L., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
Background

ESRD incidence is higher among Black and Hispanic than among White individuals. We assessed disparities in incident ESRD and death among older Medicare and younger Medicaid beneficiaries with CKD stage 4 or 5.

Methods

Non-Hispanic White, Black, and Hispanic Medicare beneficiaries aged ≥66 years with Medicare Parts A and B for at least one year and CKD stage 4 or 5 on Jan 1, 2020 were included. In a separate cohort, Medicaid enrollees aged 18-65 years with Medicaid for ≥1 year and CKD stage 4 or 5 on Jan 1, 2020 were included. Patients were followed from January 1, 2020 to the earliest of death, onset of ESRD, loss of insurance, or Dec 31, 2020. Outcomes were death, ESRD, and the combination. We estimated one-year probabilities of ESRD and death and subdistribution hazard ratios (sHRs) from Fine-Gray models with death and ESRD as competing events and adjusted for age, sex, and comorbidities.

Results

298,658 Medicare and 12,067 Medicaid beneficiaries were included. One-year probability of ESRD was 0.04 and 0.14 for Medicare CKD stages 4 and 5, respectively and 0.19 and 0.23 for death. The corresponding numbers were 0.15, 0.27, 0.07, and 0.09 for Medicaid patients. Black and Hispanic beneficiaries were more likely to reach ESRD than White patients (sHR 1.38-1.57 Medicare; 1.26-1.83 Medicaid, Figure) but were less likely to die (sHR 0.74-0.96 in Medicare and 0.68-0.96 in Medicaid). For the combined outcome, disparities were much greater in the Medicaid cohort (HR 1.14-1.47) than in Medicare (HR 0.85-1.13).

Conclusion

Older (Medicare) and younger (Medicaid) Black and Hispanic patients with CKD were at higher risk of ESRD and lower risk of death. However, disparities in risk of ESRD or death were greater in younger than older individuals. Disparities in access to care among younger individuals may be an important driver of observed ESRD disparities.

Funding

  • NIDDK Support