Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
J Am Soc Nephrol. 2010 Jul;21(7):1192-9. doi: 10.1681/ASN.2009101008. Epub 2010 Jun 17.
Referral to a nephrologist before initiation of chronic dialysis occurs less frequently for blacks than whites, but the reasons for this disparity are incompletely understood. Here, we examined the contribution of racial composition by zip code on access and quality of nephrology care before initiation of renal replacement therapy (RRT). We retrospectively studied a cohort study of 92,000 white and black adults who initiated RRT in the United States between June 1, 2005, and October 5, 2006. The percentage of patients without pre-ESRD nephrology care ranged from 30% among those who lived in zip codes with <5% black residents to 41% among those who lived in areas with >50% black residents. In adjusted analyses, as the percentage of blacks in residential areas increased, the likelihood of not receiving pre-ESRD nephrology care increased. Among patients who received nephrology care, the quality of care (timing of care and proportion of patients who received a pre-emptive renal transplant, who initiated therapy with peritoneal dialysis, or who had a permanent hemodialysis access) did not differ by the racial composition of their residential area. In conclusion, racial composition of residential areas associates with access to nephrology care but not with quality of the nephrology care received.
在开始慢性透析之前，向肾病专家转诊的情况在黑人群体中比白人群体要少，但造成这种差异的原因尚不完全清楚。在这里，我们研究了邮政编码所代表的种族构成对开始肾脏替代治疗 (RRT) 前接受肾脏病学护理的机会和质量的影响。我们回顾性地研究了一个队列研究，该研究纳入了 92000 名在 2005 年 6 月 1 日至 2006 年 10 月 5 日期间在美国开始接受 RRT 的白人和黑人成年人。在没有接受 ESRD 前期肾脏病学护理的患者中，邮政编码中黑人居民比例从<5%的地区的 30%到>50%的地区的 41%不等。在调整分析中，随着居住地区黑人比例的增加，未接受 ESRD 前期肾脏病学护理的可能性增加。在接受肾脏病学护理的患者中，护理质量（护理时机以及接受预防性肾移植、开始腹膜透析或永久性血液透析通路的患者比例）与居住地区的种族构成无关。总之，居住地区的种族构成与接受肾脏病学护理的机会有关，但与接受的肾脏病学护理质量无关。
