Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Am J Kidney Dis. 2022 Jul;80(1):9-19. doi: 10.1053/j.ajkd.2021.12.012. Epub 2022 Feb 22.
RATIONALE & OBJECTIVE: Non-Hispanic Black and Hispanic patients present with kidney failure at younger ages than White patients. Younger patients are also more likely to receive transplants and home dialysis than in-center hemodialysis (ICHD), but it is unknown whether racial and ethnic disparities in treatment differ by age. We compared use of kidney replacement therapies between racial and ethnic groups among patients with incident kidney failure overall and by age.
Retrospective cohort study.
SETTING & PARTICIPANTS: 830,402 US adult (age >21 years) patients initiating kidney failure treatment during the period of 2011-2018.
Patient race and ethnicity (non-Hispanic Black, non-Hispanic White, Hispanic, or other) and age group (22-44, 45-64, 65-74, or 75-99 years).
Treatment modality (transplant, peritoneal dialysis [PD], home hemodialysis [HHD], or ICHD) as of day 90 of treatment.
Differences in treatment modalities were quantified for patient subgroups defined by race and ethnicity and by age. Log-binomial regression models were fit to estimate adjusted risk ratios.
81% of patients were treated with ICHD, 3.0% underwent transplants (85% preemptive, 57% living-donor), 10.5% were treated with PD, and 0.7% were treated with HHD. Absolute disparities in treatment were most pronounced among patients aged 22-44 years. Compared with non-Hispanic White patients, whose percentages of treatment with transplant, PD, and HHD were 10.9%, 19.0%, and 1.2%, respectively, non-Hispanic Black patients were less commonly treated with each modality (unadjusted percentages, 1.8%, 13.8%, and 0.6%, respectively), as were Hispanic patients (4.4%, 16.9%, and 0.5%, respectively; all differences P < 0.001). After adjustment, the largest relative disparities were observed for transplant among the 22-44-year age group; compared with non-Hispanic White patients, the adjusted risk ratios for non-Hispanic Black and Hispanic patients were 0.21 (95% CI, 0.19-0.23) and 0.47 (95% CI, 0.43, 0.51), respectively.
Race and ethnicity data not self-reported.
Among adults with incident kidney failure, racial and ethnic disparities in transplant and home dialysis use are most pronounced among the youngest adult patient age group.
非西班牙裔黑人和西班牙裔患者比白种人更早出现肾衰竭。年轻患者接受移植和家庭透析（而非中心血液透析[ICHD]）的可能性也更高，但尚不清楚治疗中的种族和民族差异是否因年龄而异。我们比较了总体和按年龄分层的肾衰竭患者中，不同种族和民族群体之间使用肾脏替代疗法的情况。
回顾性队列研究。
2011 年至 2018 年期间，830,402 名美国成年（年龄>21 岁）开始接受肾衰竭治疗的患者。
患者的种族和民族（非西班牙裔黑人、非西班牙裔白人、西班牙裔或其他）和年龄组（22-44、45-64、65-74 或 75-99 岁）。
治疗后第 90 天的治疗方式（移植、腹膜透析[PD]、家庭血液透析[HHD]或 ICHD）。
通过按种族和民族以及年龄分组的患者亚组来量化治疗方式的差异。拟合对数二项式回归模型以估计调整后的风险比。
81%的患者接受 ICHD 治疗，3.0%接受移植（85%为预先移植，57%为活体供者），10.5%接受 PD 治疗，0.7%接受 HHD 治疗。在 22-44 岁年龄组的患者中，治疗方面的绝对差异最为明显。与非西班牙裔白人患者相比，非西班牙裔黑人患者接受移植、PD 和 HHD 治疗的比例分别为 10.9%、19.0%和 1.2%，而非西班牙裔黑人患者接受每种治疗的比例分别为 1.8%、13.8%和 0.6%（未经调整的百分比），西班牙裔患者分别为 4.4%、16.9%和 0.5%（所有差异 P<0.001）。调整后，22-44 岁年龄组观察到最大的相对差异，与非西班牙裔白人患者相比，非西班牙裔黑人患者和西班牙裔患者的调整风险比分别为 0.21（95%CI，0.19-0.23）和 0.47（95%CI，0.43，0.51）。
种族和民族数据不是自我报告的。
在患有突发性肾衰竭的成年患者中，在最年轻的成年患者年龄组中，种族和民族在移植和家庭透析使用方面的差异最为明显。
