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National Trends in the Association of Race and Ethnicity With Predialysis Nephrology Care in the United States From 2005 to 2015.
JAMA Netw Open. 2020 08 03; 3(8):e2015003.JN

Abstract

Importance

Predialysis nephrology care is associated with better survival among patients with end-stage kidney disease.

Objective

To examine national trends in racial/ethnic disparities in receipt of predialysis nephrology care at least 1 year before dialysis initiation in the United States from 2005 to 2015.

Design, Setting, and Participants

This national registry study assessed US registry data of 1 000 390 adults in the US Renal Data System who initiated maintenance dialysis treatment from January 1, 2005, to December 31, 2015, in multiple cross-sectional analyses. Multivariable logistic regression models were used to examine national trends in racial/ethnic disparities in receipt of predialysis nephrology care with adjustments for potential confounders. Data were analyzed April 17, 2020.

Exposure

Race/ethnicity of the patients.

Main Outcomes and Measures

Receipt of at least 12 months of predialysis nephrology care as determined by clinician-based documentation on the End Stage Renal Disease Medical Evidence Report Form CMS 2728.

Results

Among 1 000 390 adults (57.2% male; 54.6% White, 27.8% Black, 14.0% Hispanic, and 3.6% Asian; mean [SD] age, 62.4 [15.6] years) who initiated maintenance dialysis in the United States from 2005 to 2015, 310 743 (31.1%) received at least 12 months of predialysis nephrology care. In 2005 to 2007, compared with White adults, the adjusted odds ratio for receipt of at least 12 months of predialysis nephrology care was 0.82 (95% CI, 0.80-0.84) among Black adults, 0.67 (95% CI, 0.65-0.69) among Hispanic adults, and 0.84 (95% CI, 0.80-0.89) among Asian adults; in 2014 to 2015, the adjusted odds ratio was 0.76 (95% CI, 0.74-0.78) among Black adults, 0.61 (95% CI, 0.60-0.63) among Hispanic adults, and 0.90 (95% CI: 0.86-0.95) among Asian adults.

Conclusions and Relevance

In this cross-sectional study of more than 1 million US adults with end-stage kidney disease, racial and ethnic disparities in predialysis nephrology care did not substantially improve from 2005 to 2015. Study findings suggest that national strategies to address racial/ethnic disparities in predialysis nephrology care are needed.

Authors+Show Affiliations

Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Johns Hopkins Center for Health Equity, The Johns Hopkins University, Baltimore, Maryland.Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland. Johns Hopkins Center for Health Equity, The Johns Hopkins University, Baltimore, Maryland.Johns Hopkins Center for Health Equity, The Johns Hopkins University, Baltimore, Maryland. Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Johns Hopkins Center for Health Equity, The Johns Hopkins University, Baltimore, Maryland. Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland. Johns Hopkins Center for Health Equity, The Johns Hopkins University, Baltimore, Maryland.Johns Hopkins Center for Health Equity, The Johns Hopkins University, Baltimore, Maryland. Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.Kidney and Hypertension Unit, Joslin Diabetes Center and Harvard Medical School, Boston, Massachusetts.Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina.Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

32852554

Citation

Purnell, Tanjala S., et al. "National Trends in the Association of Race and Ethnicity With Predialysis Nephrology Care in the United States From 2005 to 2015." JAMA Network Open, vol. 3, no. 8, 2020, pp. e2015003.
Purnell TS, Bae S, Luo X, et al. National Trends in the Association of Race and Ethnicity With Predialysis Nephrology Care in the United States From 2005 to 2015. JAMA Netw Open. 2020;3(8):e2015003.
Purnell, T. S., Bae, S., Luo, X., Johnson, M., Crews, D. C., Cooper, L. A., Henderson, M. L., Greer, R. C., Rosas, S. E., Boulware, L. E., & Segev, D. L. (2020). National Trends in the Association of Race and Ethnicity With Predialysis Nephrology Care in the United States From 2005 to 2015. JAMA Network Open, 3(8), e2015003. https://doi.org/10.1001/jamanetworkopen.2020.15003
Purnell TS, et al. National Trends in the Association of Race and Ethnicity With Predialysis Nephrology Care in the United States From 2005 to 2015. JAMA Netw Open. 2020 08 3;3(8):e2015003. PubMed PMID: 32852554.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - National Trends in the Association of Race and Ethnicity With Predialysis Nephrology Care in the United States From 2005 to 2015. AU - Purnell,Tanjala S, AU - Bae,Sunjae, AU - Luo,Xun, AU - Johnson,Morgan, AU - Crews,Deidra C, AU - Cooper,Lisa A, AU - Henderson,Macey L, AU - Greer,Raquel C, AU - Rosas,Sylvia E, AU - Boulware,L Ebony, AU - Segev,Dorry L, Y1 - 2020/08/03/ PY - 2020/8/28/entrez PY - 2020/8/28/pubmed PY - 2020/12/22/medline SP - e2015003 EP - e2015003 JF - JAMA network open JO - JAMA Netw Open VL - 3 IS - 8 N2 - Importance: Predialysis nephrology care is associated with better survival among patients with end-stage kidney disease. Objective: To examine national trends in racial/ethnic disparities in receipt of predialysis nephrology care at least 1 year before dialysis initiation in the United States from 2005 to 2015. Design, Setting, and Participants: This national registry study assessed US registry data of 1 000 390 adults in the US Renal Data System who initiated maintenance dialysis treatment from January 1, 2005, to December 31, 2015, in multiple cross-sectional analyses. Multivariable logistic regression models were used to examine national trends in racial/ethnic disparities in receipt of predialysis nephrology care with adjustments for potential confounders. Data were analyzed April 17, 2020. Exposure: Race/ethnicity of the patients. Main Outcomes and Measures: Receipt of at least 12 months of predialysis nephrology care as determined by clinician-based documentation on the End Stage Renal Disease Medical Evidence Report Form CMS 2728. Results: Among 1 000 390 adults (57.2% male; 54.6% White, 27.8% Black, 14.0% Hispanic, and 3.6% Asian; mean [SD] age, 62.4 [15.6] years) who initiated maintenance dialysis in the United States from 2005 to 2015, 310 743 (31.1%) received at least 12 months of predialysis nephrology care. In 2005 to 2007, compared with White adults, the adjusted odds ratio for receipt of at least 12 months of predialysis nephrology care was 0.82 (95% CI, 0.80-0.84) among Black adults, 0.67 (95% CI, 0.65-0.69) among Hispanic adults, and 0.84 (95% CI, 0.80-0.89) among Asian adults; in 2014 to 2015, the adjusted odds ratio was 0.76 (95% CI, 0.74-0.78) among Black adults, 0.61 (95% CI, 0.60-0.63) among Hispanic adults, and 0.90 (95% CI: 0.86-0.95) among Asian adults. Conclusions and Relevance: In this cross-sectional study of more than 1 million US adults with end-stage kidney disease, racial and ethnic disparities in predialysis nephrology care did not substantially improve from 2005 to 2015. Study findings suggest that national strategies to address racial/ethnic disparities in predialysis nephrology care are needed. SN - 2574-3805 UR - https://www.unboundmedicine.com/medline/citation/32852554/National_Trends_in_the_Association_of_Race_and_Ethnicity_With_Predialysis_Nephrology_Care_in_the_United_States_From_2005_to_2015_ DB - PRIME DP - Unbound Medicine ER -