Race and end-stage renal disease in the United States Medicare population: the disparity persists.
OBJECTIVE
A marked preponderance of end-stage renal disease among African Americans was described more than two decades ago. The objective of this study was to determine whether racial disparities in end-stage renal disease in the United States have changed over time.


METHODS
The authors compared renal replacement therapy rates in five biennial cohorts (1993-1994, 1995-1996, 1997-1998, 1999-2000, 2001-2002; n = 6 315 283), using annual random samples of 5% of the US Medicare population and the United States Renal Data System registry.


RESULTS
The proportion of African American subjects rose from 8.8% in the first cohort to 9.4% in the last. Renal replacement therapy rates (per 1000 patient-years) among white Americans in successive cohorts were 0.84, 0.96, 1.08, 1.16 and 1.20, compared with 2.98, 3.24, 3.65, 3.80 and 3.57 among African Americans (P < 0.0001 for race comparison within each biennial cohort). Corresponding hazards ratios, adjusted for demographic characteristics and comorbid conditions, were 2.01 (95% confidence interval 1.82-2.33), 1.96 (1.78-2.17), 2.00 (1.81-2.20), 2.01 (1.83-2.21) and 1.86 (1.69-2.04), suggesting the absence of meaningful reduction in racial disparities in renal replacement therapy rates over time.


CONCLUSIONS
Disparities in renal replacement therapy rates between white and African American Medicare beneficiaries have persisted over time.
Tomson
Charles R V
CR
Southmead Hospital, Bristol, UK.
Foley
Robert N
RN
Li
Qi
Q
Gilbertson
David T
DT
Xue
Jay L
JL
Collins
Allan J
AJ
D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000208:ethnology* / Q000628:therapy; D008297:Male; D006278:Medicare; D017582:Renal Replacement Therapy; D014481:United States / Q000453:epidemiology; D044465:White People