Wallace Eric L, Lea Janice, Chaudhary Ninad S, Griffin Russell, Hammelman Eric, Cohen Joshua, Sloand James A
Department of Medicine, Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
Emory University, Atlanta, GA, USA.
Perit Dial Int. 2017;37(1):21-29. doi: 10.3747/pdi.2016.00025. Epub 2016 Sep 28.
♦ BACKGROUND: United States Renal Data System (USRDS) data from 2014 show that African Americans (AA) are underrepresented in the home dialysis population, with 6.4% versus 9.2% utilization in the general populace. This racial disparity may be inaccurately ascribed to the nation as a whole if regional and inter-state variability exists. This investigation sought to examine home dialysis utilization by minority Medicare beneficiary populations across the US nationally, regionally, and by individual state. ♦ METHODS: The 2012 Medicare 100% Outpatient Standard Analytic File was used to identify all Medicare fee-for-service (FFS) patients, with state of residence and race, receiving an outpatient dialysis facility bill type. Peritoneal dialysis (PD) and home hemodialysis (HHD) patients were identified using revenue and condition codes and were defined by having at least one claim during the year that met criteria for the category. Beneficiaries were counted once for each modality used that year. A home dialysis utilization ratio (UR) was calculated as the ratio of the proportion of a minority on PD or HHD within a geographic division to the proportion of Caucasians on PD or HHD within the same geographic division. A UR less than 1.00 indicated under-representation while a UR over 1.00 indicated over-representation. Utilization ratios were compared using a Poisson regression model. ♦ RESULTS: A total of 369,164 Medicare FFS dialysis patients were identified. Within the total cohort, AA were the most underrepresented minority on PD (UR 0.586; 95% confidence interval [CI]: 0.585 - 0.586; p < 0.0001), followed by Hispanics (UR 0.744; 95% CI 0.743 - 0.744; p < 0.0001). The underutilization of PD by AA and Hispanics could not be ascribed to any region of the US, as all regions of the US had UR < 1.00. Only Massachusetts had a UR > 1.00 for AA on PD. Peritoneal dialysis UR values for Asians and those self-identified as Other were 0.954; 95% CI 0.953 - 0.954 and 0.932; 95% CI 0.931 - 0.932, respectively. Nationally, all minorities utilized HHD less than Caucasians. However, more variability existed, with Asians utilizing more HHD than Caucasians in the Midwest. ♦ CONCLUSIONS: Although regional and interstate variability exists, there is near universal under-representation of AA and Hispanics in the home dialysis population, while Asians and Other demonstrate more interregional and interstate variability.
♦ 背景：美国肾脏数据系统（USRDS）2014年的数据显示，非裔美国人（AA）在家用透析人群中的占比不足，在普通人群中的使用率为6.4%，而普通人群的使用率为9.2%。如果存在地区和州际差异，这种种族差异可能会被不准确地归咎于整个国家。本研究旨在调查全美、各地区以及各个州的少数族裔医疗保险受益人群的家用透析使用率。♦ 方法：使用2012年医疗保险100%门诊标准分析文件来识别所有接受门诊透析设施账单类型的医疗保险按服务收费（FFS）患者，并确定其居住州和种族。通过收入和病情代码识别腹膜透析（PD）和家庭血液透析（HHD）患者，并定义为在该年度至少有一次符合该类别标准的索赔。当年使用的每种透析方式的受益人各计一次。计算家用透析使用率（UR），即地理区域内少数族裔在PD或HHD上的比例与同一地理区域内白种人在PD或HHD上的比例之比。UR小于1.00表示代表性不足，而UR大于1.00表示代表性过高。使用泊松回归模型比较使用率。♦ 结果：共识别出369,164名医疗保险FFS透析患者。在整个队列中，AA是PD上代表性最不足的少数族裔（UR 0.586；95%置信区间[CI]：0.585 - 0.586；p < 0.0001），其次是西班牙裔（UR 0.744；95% CI 0.743 - 0.744；p < 0.0001）。AA和西班牙裔对PD的利用不足不能归因于美国的任何地区，因为美国所有地区的UR均<1.00。只有马萨诸塞州AA在PD上的UR>1.00。亚洲人和自我认定为其他种族的人在PD上的UR值分别为0.954；95% CI 0.953 - 0.954和0.932；95% CI 0.931 - 0.932。在全国范围内，所有少数族裔使用HHD的比例均低于白种人。然而，差异更大，中西部地区的亚洲人使用HHD的比例高于白种人。♦ 结论：尽管存在地区和州际差异，但在家用透析人群中，AA和西班牙裔几乎普遍代表性不足，而亚洲人和其他种族则表现出更大的地区间和州际差异。
