title: Receipt of renal replacement therapy in the United States: a population-based study of sociodemographic disparities from the Second National Health and Nutrition Examination Survey (NHANES II).
abstract: BACKGROUND
  Persons with chronic kidney disease who need kidney replacement therapy to sustain life have health insurance. We examined whether young adults, women, blacks, less-educated persons, the poor, and persons residing in less populated areas receive treatment when health insurance is no longer a barrier.
  
  
  METHODS
  We conducted a case-control study nested in the Second National Health and Nutrition Examination Survey Mortality Study. Cases were persons treated with kidney replacement therapy determined by linkage to the end-stage renal disease treatment registry. Controls were untreated persons with kidney disease who died not appearing in the registry.
  
  
  RESULTS
  During 12 to 16 years, 44 persons developed treated disease, and 145 persons, untreated disease. After adjustment for sex, age, education, population of residential area, and comorbid conditions in logistic regression analysis, younger versus older age and living in a highly populated versus less populated area were both independently associated with treatment (relative odds of treatment, 5.57; 95% confidence interval, 1.72 to 18.0; and 4.33; 95% confidence interval, 2.09 to 8.97, respectively). Race, sex, education, and poverty were not associated with less treatment.
  
  
  CONCLUSIONS
  We found no disparity in life-saving chronic kidney disease treatment with regard to race or socioeconomic status in this population-based study. Less receipt of treatment by older adults may reflect greater comorbid disease or choices made by persons or their providers. Strategies to render treatment in less populated areas, including incentives to deliver care to such areas, should be encouraged.
authors.affiliation: Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD 21205-2223, USA. npowe@jhmi.edu
authors.forename: Neil R
authors.initials: NR
authors.lastname: Powe
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Tarver-Carr
authors.forename: Mark S
authors.initials: MS
authors.lastname: Eberhardt
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Brancati
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D011203:Poverty; D012042:Registries; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data*; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology