Ethnicity, socioeconomic status, and attainment of clinical practice guideline standards in dialysis patients in the United kingdom.
OBJECTIVE
The role of socioeconomic status (SES) and its contribution to ethnic differences in standards attainment among dialysis patients is not known.


METHODS
We examined associations between area- level SES (Townsend index) and ethnicity (white, black, South Asian) and standards attainment in 14,117 incident dialysis patients (1997-2004) in the UK.


RESULTS
Deprived patients were less likely to achieve hemoglobin (Hb) > or = 10 g/dl (trend P < 0.001) but not after controlling for patient and center characteristics (trend P = 0.1). There was no association with hemodialysis dose and parathyroid hormone (PTH) standard but deprived patients had better attainment of phosphate (PO4) <5.6 mg/dl, calcium (Ca) and Calcium-phosphate (CaPO4) standard (e.g., most deprived versus least deprived adjusted odds ratio [OR] 1.25, 95% confidence intervals [CI] 1.12, 1.38). There was no association with SES using a lower limit for PO4 (3.5 - 5.5 mg/dl). Compared with Whites, Blacks had lower attainment of Hb (adjusted OR 0.57, 95% CI 0.45, 0.71) and PTH standards (adjusted OR 0.27, 95% CI 0.22, 0.33) but better attainment of PO4 and CaPO4, while South Asians experienced better or comparable outcomes for most standards except Ca and PTH.


CONCLUSIONS
There was no evidence of socioeconomic inequity in standards attainment or a consistent pattern of inequity by ethnic group. The lower attainment of some standards in ethnic minorities may reflect biologic differences rather than ethnicity-related inequity of care.
UK Renal Registry, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, UK. uday@renalreg.com
Udaya P
UP
Udayaraj
Yoav
Y
Ben-Shlomo
Paul
P
Roderick
Retha
R
Steenkamp
David
D
Ansell
Charles R V
CR
Tomson
Fergus J
FJ
Caskey
D000293:Adolescent; D000328:Adult; D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data; D044383:Black People / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D012042:Registries / Q000706:statistics & numerical data; D006435:Renal Dialysis / Q000592:standards* / Q000706:statistics & numerical data*; D012923:Social Class; D006113:United Kingdom / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
D006454:Hemoglobins; C470125:PTH protein, human; D010281:Parathyroid Hormone