Trends in relative mortality between hispanic and non-hispanic whites initiating dialysis

A retrospective study of the us renal data system

Cristina M. Arce, Benjamin A. Goldstein, Aya A. Mitani, Wolfgang C. Winkelmayer

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Background: Hispanic patients undergoing long-term dialysis experience better survival compared with non-Hispanic whites. It is unknown whether this association differs by age, has changed over time, or is due to differential access to kidney transplantation. Study Design: National retrospective cohort study. Setting & Participants: Using the US Renal Data System, we identified 615,618 white patients 18 years or older who initiated dialysis therapy between January 1, 1995, and December 31, 2007. Predictors: Hispanic ethnicity (vs non-Hispanic whites), year of end-stage renal disease incidence, age (as potential effect modifier). Outcomes: All-cause and cause-specific mortality. Results: We found that Hispanics initiating dialysis therapy experienced lower mortality, but age modified this association (P < 0.001). Compared with non-Hispanic whites, mortality in Hispanics was 33% lower at ages 18-39 years (adjusted cause-specific HR [HRcs], 0.67; 95% CI, 0.64-0.71) and 40-59 years (HRcs, 0.67; 95% CI, 0.66-0.68), 19% lower at ages 60-79 years (HRcs, 0.81; 95% CI, 0.80-0.82), and 6% lower at 80 years or older (HRcs, 0.94; 95% CI, 0.91-0.97). Accounting for the differential rates of kidney transplantation, the associations were attenuated markedly in the younger age strata; the survival benefit for Hispanics was reduced from 33% to 10% at ages 18-39 years (adjusted subdistribution-specific HR [HRsd], 0.90; 95% CI, 0.85-0.94) and from 33% to 19% among those aged 40-59 years (HRsd, 0.81; 95% CI, 0.80-0.83). Limitations: Inability to analyze Hispanic subgroups that may experience heterogeneous mortality outcomes. Conclusions: Overall, Hispanics experienced lower mortality, but differential access to kidney transplantation was responsible for much of the apparent survival benefit noted in younger Hispanics.

Original languageEnglish (US)
Pages (from-to)312-321
Number of pages10
JournalAmerican Journal of Kidney Diseases
Volume62
Issue number2
DOIs
StatePublished - Aug 1 2013

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Hispanic Americans
Information Systems
Dialysis
Retrospective Studies
Kidney
Mortality
Kidney Transplantation
Survival
Chronic Kidney Failure
Cohort Studies
Incidence
Therapeutics

Keywords

  • Clinical epidemiology
  • dialysis
  • Hispanic ethnicity
  • survival

ASJC Scopus subject areas

  • Nephrology

Cite this

Trends in relative mortality between hispanic and non-hispanic whites initiating dialysis : A retrospective study of the us renal data system. / Arce, Cristina M.; Goldstein, Benjamin A.; Mitani, Aya A.; Winkelmayer, Wolfgang C.

In: American Journal of Kidney Diseases, Vol. 62, No. 2, 01.08.2013, p. 312-321.

Research output: Contribution to journalArticle

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abstract = "Background: Hispanic patients undergoing long-term dialysis experience better survival compared with non-Hispanic whites. It is unknown whether this association differs by age, has changed over time, or is due to differential access to kidney transplantation. Study Design: National retrospective cohort study. Setting & Participants: Using the US Renal Data System, we identified 615,618 white patients 18 years or older who initiated dialysis therapy between January 1, 1995, and December 31, 2007. Predictors: Hispanic ethnicity (vs non-Hispanic whites), year of end-stage renal disease incidence, age (as potential effect modifier). Outcomes: All-cause and cause-specific mortality. Results: We found that Hispanics initiating dialysis therapy experienced lower mortality, but age modified this association (P < 0.001). Compared with non-Hispanic whites, mortality in Hispanics was 33{\%} lower at ages 18-39 years (adjusted cause-specific HR [HRcs], 0.67; 95{\%} CI, 0.64-0.71) and 40-59 years (HRcs, 0.67; 95{\%} CI, 0.66-0.68), 19{\%} lower at ages 60-79 years (HRcs, 0.81; 95{\%} CI, 0.80-0.82), and 6{\%} lower at 80 years or older (HRcs, 0.94; 95{\%} CI, 0.91-0.97). Accounting for the differential rates of kidney transplantation, the associations were attenuated markedly in the younger age strata; the survival benefit for Hispanics was reduced from 33{\%} to 10{\%} at ages 18-39 years (adjusted subdistribution-specific HR [HRsd], 0.90; 95{\%} CI, 0.85-0.94) and from 33{\%} to 19{\%} among those aged 40-59 years (HRsd, 0.81; 95{\%} CI, 0.80-0.83). Limitations: Inability to analyze Hispanic subgroups that may experience heterogeneous mortality outcomes. Conclusions: Overall, Hispanics experienced lower mortality, but differential access to kidney transplantation was responsible for much of the apparent survival benefit noted in younger Hispanics.",
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N2 - Background: Hispanic patients undergoing long-term dialysis experience better survival compared with non-Hispanic whites. It is unknown whether this association differs by age, has changed over time, or is due to differential access to kidney transplantation. Study Design: National retrospective cohort study. Setting & Participants: Using the US Renal Data System, we identified 615,618 white patients 18 years or older who initiated dialysis therapy between January 1, 1995, and December 31, 2007. Predictors: Hispanic ethnicity (vs non-Hispanic whites), year of end-stage renal disease incidence, age (as potential effect modifier). Outcomes: All-cause and cause-specific mortality. Results: We found that Hispanics initiating dialysis therapy experienced lower mortality, but age modified this association (P < 0.001). Compared with non-Hispanic whites, mortality in Hispanics was 33% lower at ages 18-39 years (adjusted cause-specific HR [HRcs], 0.67; 95% CI, 0.64-0.71) and 40-59 years (HRcs, 0.67; 95% CI, 0.66-0.68), 19% lower at ages 60-79 years (HRcs, 0.81; 95% CI, 0.80-0.82), and 6% lower at 80 years or older (HRcs, 0.94; 95% CI, 0.91-0.97). Accounting for the differential rates of kidney transplantation, the associations were attenuated markedly in the younger age strata; the survival benefit for Hispanics was reduced from 33% to 10% at ages 18-39 years (adjusted subdistribution-specific HR [HRsd], 0.90; 95% CI, 0.85-0.94) and from 33% to 19% among those aged 40-59 years (HRsd, 0.81; 95% CI, 0.80-0.83). Limitations: Inability to analyze Hispanic subgroups that may experience heterogeneous mortality outcomes. Conclusions: Overall, Hispanics experienced lower mortality, but differential access to kidney transplantation was responsible for much of the apparent survival benefit noted in younger Hispanics.

AB - Background: Hispanic patients undergoing long-term dialysis experience better survival compared with non-Hispanic whites. It is unknown whether this association differs by age, has changed over time, or is due to differential access to kidney transplantation. Study Design: National retrospective cohort study. Setting & Participants: Using the US Renal Data System, we identified 615,618 white patients 18 years or older who initiated dialysis therapy between January 1, 1995, and December 31, 2007. Predictors: Hispanic ethnicity (vs non-Hispanic whites), year of end-stage renal disease incidence, age (as potential effect modifier). Outcomes: All-cause and cause-specific mortality. Results: We found that Hispanics initiating dialysis therapy experienced lower mortality, but age modified this association (P < 0.001). Compared with non-Hispanic whites, mortality in Hispanics was 33% lower at ages 18-39 years (adjusted cause-specific HR [HRcs], 0.67; 95% CI, 0.64-0.71) and 40-59 years (HRcs, 0.67; 95% CI, 0.66-0.68), 19% lower at ages 60-79 years (HRcs, 0.81; 95% CI, 0.80-0.82), and 6% lower at 80 years or older (HRcs, 0.94; 95% CI, 0.91-0.97). Accounting for the differential rates of kidney transplantation, the associations were attenuated markedly in the younger age strata; the survival benefit for Hispanics was reduced from 33% to 10% at ages 18-39 years (adjusted subdistribution-specific HR [HRsd], 0.90; 95% CI, 0.85-0.94) and from 33% to 19% among those aged 40-59 years (HRsd, 0.81; 95% CI, 0.80-0.83). Limitations: Inability to analyze Hispanic subgroups that may experience heterogeneous mortality outcomes. Conclusions: Overall, Hispanics experienced lower mortality, but differential access to kidney transplantation was responsible for much of the apparent survival benefit noted in younger Hispanics.

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