Disparity in outcomes for adult Native American hemodialysis patients? Findings from the ESRD Clinical Performance Measures Project, 1996 to 1999.
BACKGROUND
There is a paucity of information regarding the quality of care for Native American hemodialysis patients. Outcomes, including 1-year hospitalization and mortality, for adult Native American in-center hemodialysis patients selected for the Centers for Medicare and Medicaid (CMS) end-stage renal disease (ESRD) Clinical Performance Measures (CPM) Project were compared to those for white and black patients to determine if disparity in care existed for this group.


METHODS
Clinical data were abstracted from medical records for the last quarters of 1995 to 1998 and linked to United States Renal Data System (USRDS) data files for data on comorbidities and 1-year hospitalization and mortality. Associations of race were tested by bivariate analyses and multivariate logistic regression and Cox proportional hazard modeling.


RESULTS
Two percent (467 of 27876) of patients were Native American, 37% black, and 51% white. Native American, compared to black and white patients, were more likely to have diabetes mellitus as the cause of ESRD (72%, 37%, and 38%, respectively, P < 0.01). In multivariate analyses, Native American patients were more likely to achieve a mean urea reduction ratio (URR) > or = 65% compared to whites (referent) [hazards ratio (HR) (95% CI) 1.7 (1.3, 2.2)] and be dialyzed with an arteriovenous fistula [HR (95% CI) 1.7 (1.2, 2.5)]. They were as likely as Whites to achieve a mean hematocrit > or =33% and a mean serum albumin > or =4.0/3.7 g/dL. In multivariate analyses, Native Americans were no more likely to be hospitalized or die during the follow-up period than whites.


CONCLUSIONS
These data suggest that adult Native American hemodialysis patients experience equivalent or better dialytic care and are no more likely to experience 1-year hospitalization or mortality compared to whites.
Frankenfield
Diane L
DL
Centers for Medicare and Medicaid Services, Center for Beneficiary Choices, Baltimore, Maryland 21244, USA. dfrankenfield@cms.hhs.gov
Roman
Sheila H
SH
Rocco
Michael V
MV
Bedinger
Marjorie R
MR
McClellan
William M
WM
D000368:Aged; D044383:Black People; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007198:Indians, North American; D007676:Kidney Failure, Chronic / Q000150:complications / Q000208:ethnology* / Q000401:mortality / Q000628:therapy*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D044465:White People; D001741:Black or African American