Gao Sam W, Oliver David K, Das Neal, Hurst Frank P, Lentine Krista L, Agodoa Lawrence Y, Sawyers Eric S, Abbott Kevin C
Nephrology Service, National Naval Medical Center, Bethesda, Maryland, USA.
Clin J Am Soc Nephrol. 2008 Mar;3(2):442-9. doi: 10.2215/CJN.03940907. Epub 2008 Jan 16.
Racial disparities in provision of healthcare are widespread in the United States but have not been specifically assessed in provision of chronic kidney disease (CKD) care.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a retrospective cohort study of the clinical database used in a Department of Defense (DOD) medical system. Beneficiaries studied were DOD-eligible beneficiaries with CKD stage 3 (n = 7729) and 4 (n = 589) using the modified Modification of Diet in Renal Disease (MDRD)-estimated GFR formula but requiring manual correction for Black race. Compliance with selected Kidney Disease Outcomes Quality Initiative (KDOQI) CKD recommended targets (monitoring of recommended laboratory data, prescription of recommended medications, and referral to nephrology) was assessed over a 12-mo period, stratified by CKD stage. Logistic regression analysis was used to assess whether race (White, Black, or other) was independently associated with provider compliance with targets, adjusted for demographic factors and burden of comorbid conditions.
Among the targets, only monitoring of LDL cholesterol was significantly less common among Blacks. For all other measures, compliance was either not significantly different or significantly higher for Black compared with White beneficiaries. However, patients categorized as "Other" race were in general less likely to achieve targets than Whites, and at stage 3 CKD significantly less likely to achieve targets for monitoring of phosphorous, hemoglobin, and vitamin D.
In the DOD health system, provider compliance with selected CKD stage 3 and 4 targets was not significantly lower for Black beneficiaries than for Whites, with the exception of LDL cholesterol monitoring. Patients classified as Other race were generally less likely to achieve targets than Whites, in some patients significantly so.
美国医疗保健服务中的种族差异普遍存在，但慢性肾脏病（CKD）护理方面的差异尚未得到具体评估。
设计、地点、参与者及测量方法：我们对国防部（DOD）医疗系统使用的临床数据库进行了一项回顾性队列研究。研究对象为符合国防部条件的CKD 3期（n = 7729）和4期（n = 589）受益患者，使用改良的肾脏病饮食改良（MDRD）估算肾小球滤过率公式，但黑人种族需手动校正。在12个月期间，按CKD分期分层，评估对选定的肾脏病预后质量倡议（KDOQI）CKD推荐目标（推荐实验室数据监测、推荐药物处方及转诊至肾脏病科）的依从性。采用逻辑回归分析评估种族（白人、黑人或其他）是否与提供者对目标的依从性独立相关，并对人口统计学因素和合并症负担进行校正。
在各项指标中，只有黑人中低密度脂蛋白胆固醇的监测显著较少见。对于所有其他指标，黑人受益患者的依从性与白人相比要么无显著差异，要么显著更高。然而，分类为“其他”种族的患者总体上比白人更难达到目标，在CKD 3期，达到磷、血红蛋白和维生素D监测目标的可能性显著更低。
在国防部卫生系统中，除了低密度脂蛋白胆固醇监测外，黑人受益患者的提供者对选定的CKD 3期和4期目标的依从性并不显著低于白人。分类为其他种族的患者总体上比白人更难达到目标，在某些患者中差异显著。
