Previous studies suggest disparities in health service usage between African Americans and whites. However, it is not known whether African Americans are less likely to receive kidney replacement therapy when they develop ESRD, a condition for which they are at higher risk than other ethnic groups. Therefore, we conducted a case-control study nested in the Second National Health and Nutrition Examination Survey (NHANES II) Mortality Study, a non-concurrent cohort study of 9250 adults aged 30-74 examined in NHANES II (1976-1980). Death was ascertained by matching to national mortality files through 1992. Incident cases of treated ESRD (i.e., chronic dialysis or transplantation) were determined by linkage to the Medicare ESRD Registry. Incident cases of untreated ESRD were defined as deaths attributed to kidney-related ICD-9 codes among adults not appearing in the registry. Over 16 years, 42 persons developed treated ESRD and 148 untreated ESRD. Compared to those who died without treatment, adults treated for ESRD were more likely to be younger, more educated, urban residents, and African American. Without adjustment, African Americans were more likely to be treated for ESRD than whites (odds ratio (OR)=4.0, 95% confidence interval [CI]=1.2-13.4). After adjusting for gender, age, education, place of residence (rural, town, urban), and co-morbid conditions at baseline in multiple logistic regression analysis, the treatment difference was less and became non-significant (OR=2.1, 95% CI=0.6-7.6). These data suggest that African Americans and whites have similar access to initial ESRD treatment. This may result from the provision of national insurance to nearly all who develop ESRD.
Learning Objectives: At the conclusion of the session, the participant in this session will be able to: 1. Understand the potential benefits of linking existing data sets with treatment registries. 2. Understand racial differences in access to kidney replacement therapy in a nationally representative sample
Keywords: Access and Services, Minority Research
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.