Differences in mortality among Mexican-American, Puerto Rican, and Cuban-American dialysis patients in the United States.
BACKGROUND
The Hispanic ethnic group is heterogeneous, with distinct genetic, cultural, and socioeconomic characteristics, but most prior studies of patients with end-stage renal disease focus on the overall Hispanic ethnic group without further granularity. We examined survival differences among Mexican-American, Puerto Rican, and Cuban-American dialysis patients in the United States.


METHODS
Prospective observational study.


METHODS
Data from individuals randomly selected for the End-Stage Renal Disease Clinical Performance Measures Project (2001 to 2005) were examined. Mexican-American (n = 2,742), Puerto Rican (n = 838), Cuban-American (n = 145), and Hispanic-other dialysis patients (n = 942) were compared with each other and with non-Hispanic (n = 33,076) dialysis patients in the United States.


METHODS
Patient characteristics of interest included ethnicity/race, comorbidities, and specific available laboratory values.


RESULTS
The major outcome of interest was mortality.


RESULTS
In the fully adjusted multivariable model, 2-year mortality risk was significantly lower for the Mexican-American and Hispanic-other groups compared with non-Hispanics (adjusted hazard ratio, 0.79; 95% confidence interval, 0.73 to 0.85; adjusted hazard ratio, 0.81; 95% confidence interval, 0.71 to 0.92, respectively). Differences in 2-year mortality rates within the Hispanic ethnic groups were statistically significant (P = 0.004) and ranged from 21% lower mortality in Mexican Americans to 3% higher mortality in Puerto Ricans compared with non-Hispanics.


CONCLUSIONS
Include those inherent to an observational study, potential ethnic group misclassification, and small sample sizes for some Hispanic subgroups.


CONCLUSIONS
Mexican-American and Hispanic-other dialysis patients have a survival advantage compared with non-Hispanics. Furthermore, Mexican Americans, Cuban Americans, and Hispanic others had a survival advantage compared with their Puerto Rican counterparts. Future research should continue to examine subgroups within Hispanic ethnicity to understand underlying reasons for observed differences that may be masked by examining the Hispanic ethnic group as only a single entity.
Frankenfield
Diane L
DL
Centers for Medicare & Medicaid Services, Office of Research, Development and Information, Baltimore, MD, USA.
Krishnan
Sangeetha M
SM
Ashby
Valarie B
VB
Shearon
Tempie H
TH
Rocco
Michael V
MV
Saran
Rajiv
R
D000328:Adult; D000368:Aged; D005260:Female; D006630:Hispanic or Latino / Q000208:ethnology* / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000208:ethnology* / Q000401:mortality* / Q000628:therapy; D008297:Male; D017058:Mexican Americans / Q000208:ethnology* / Q000706:statistics & numerical data; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology