Background: Historically, non-white populations have worse outcomes than whites for most medical problems. A surprising exception is in End Stage Renal Disease (ESRD) where non-white dialysis patients survive longer. We sought to understand this better, using a clinically rich data set to make risk-adjusted comparisons. Methods: We examined 5,000 cases from the US Renal Data System Case Mix Severity Study, followed for up to six years, to build multivariable proportional hazard models to predict survival of ESRD patients receiving dialysis, and to make risk adjusted comparisons of survival by race. Results: The unadjusted relative risk RR of death for nonwhite patients was 0.64 (95% CI: 0.58 to 0.70). Factors that negatively impact survival were increasing age; presence of diabetes; histories of myocardial infarction, congestive heart failure, peripheral vascular disease or malignancy; current smoking and poor nutritional status, especially low serum albumin. After risk-adjustment, the non-white survival advantage was reduced (RR=0.78) but did not disappear (95% CI: 0.71 to 0.86). Conclusions: The detailed clinic data collected in special studies of ESRD populations (but not routinely available for all patients) is important for examining differences in survival. However, the racial advantage of whites in ESRD survival is not fully explained by such information.
Learning Objectives: Learn about the data available for research on Medicare's End Stage Renal Disease (ESRD) program. Become familiar with the clinically and otherwise rich data available for a nationally representative ESRD study population (race and other demographics, as well as clinical, utilization and outcome information). Understand how a large observed survival advantage for non-white ESRD patients is affected by both basic, and more-clinically detailed, risk adjustment
Keywords: Chronic Diseases, Medicare
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.