Racial disparities in the prevalence of cardiovascular disease among incident end-stage renal disease patients.
BACKGROUND
Prevalence of coronary heart disease (CHD) and heart failure (HF) is higher among blacks as compared with whites in general population. This study describes unexpected racial differences in the prevalence of CHD and HF among incident dialysis patients, with whites being at a disadvantage.


METHODS
Data were obtained from Centers for Medicare and Medicaid Services (CMS) 2728 form for incident dialysis patients in Georgia, North Carolina and South Carolina in 1995-2003. The CHD and HF prevalence between races were compared using adjusted odds ratios (ORs). The potential for case ascertainment bias was assessed.


RESULTS
Compared with whites (n = 23 951), black patients (n = 32 642) had lower prevalence of CHD (15.7 vs 31.2%) and HF (28.1 vs 34.1%). After controlling for age, gender, diabetes, hypertension and smoking, the association of race with CHD varied by gender and diabetes status: OR ranged from 0.36 (0.34-0.39) for non-diabetic males to 0.57 (0.53-0.61) for diabetic females. Racial differences were not fully explained by case ascertainment bias. The race-HF association varied by age, gender and diabetes: among patients aged <55, blacks tended to have higher prevalence than whites (OR ranged from 0.99 (0.90-1.09) for diabetic males to 1.25 (1.13-1.39) for non-diabetic females), but among those aged above 55, blacks were less likely to HF (OR ranged from 0.62 (0.58-0.67) for diabetic males to 0.79 (0.73-0.85) for non-diabetic females).


CONCLUSIONS
Substantial racial disparities exist in CHD/HF prevalence among incident dialysis patients that persist after controlling for confounders and cannot be fully explained by disease misclassification.
Volkova
Nataliya
N
Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, N.E., Atlanta, GA 30322, USA. nvolkov@sph.emory.edu
McClellan
William
W
Soucie
J Michael
JM
Schoolwerth
Anton
A
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000208:ethnology*; D015897:Comorbidity; D003327:Coronary Disease / Q000208:ethnology; D003920:Diabetes Mellitus / Q000208:ethnology; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006333:Heart Failure / Q000208:ethnology; D006801:Humans; D006973:Hypertension / Q000208:ethnology; D007676:Kidney Failure, Chronic / Q000208:ethnology* / Q000628:therapy; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D009765:Obesity / Q000208:ethnology; D016017:Odds Ratio; D015995:Prevalence; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015983:Selection Bias; D013022:South Carolina / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*