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Trends in relative mortality between Hispanic and non-Hispanic whites initiating dialysis: a retrospective study of the US Renal Data System.

Publication ,  Journal Article
Arce, CM; Goldstein, BA; Mitani, AA; Winkelmayer, WC
Published in: Am J Kidney Dis
August 2013

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.

Duke Scholars

Published In

Am J Kidney Dis

DOI

EISSN

1523-6838

Publication Date

August 2013

Volume

62

Issue

2

Start / End Page

312 / 321

Location

United States

Related Subject Headings

  • Young Adult
  • White People
  • Urology & Nephrology
  • United Nations
  • Retrospective Studies
  • Renal Dialysis
  • Middle Aged
  • Male
  • Kidney Failure, Chronic
  • Humans
 

Citation

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Arce, C. M., Goldstein, B. A., Mitani, A. A., & Winkelmayer, W. C. (2013). Trends in relative mortality between Hispanic and non-Hispanic whites initiating dialysis: a retrospective study of the US Renal Data System. Am J Kidney Dis, 62(2), 312–321. https://doi.org/10.1053/j.ajkd.2013.02.375
Arce, Cristina M., Benjamin A. Goldstein, Aya A. Mitani, and Wolfgang C. Winkelmayer. “Trends in relative mortality between Hispanic and non-Hispanic whites initiating dialysis: a retrospective study of the US Renal Data System.Am J Kidney Dis 62, no. 2 (August 2013): 312–21. https://doi.org/10.1053/j.ajkd.2013.02.375.
Arce, Cristina M., et al. “Trends in relative mortality between Hispanic and non-Hispanic whites initiating dialysis: a retrospective study of the US Renal Data System.Am J Kidney Dis, vol. 62, no. 2, Aug. 2013, pp. 312–21. Pubmed, doi:10.1053/j.ajkd.2013.02.375.
Journal cover image

Published In

Am J Kidney Dis

DOI

EISSN

1523-6838

Publication Date

August 2013

Volume

62

Issue

2

Start / End Page

312 / 321

Location

United States

Related Subject Headings

  • Young Adult
  • White People
  • Urology & Nephrology
  • United Nations
  • Retrospective Studies
  • Renal Dialysis
  • Middle Aged
  • Male
  • Kidney Failure, Chronic
  • Humans