title: The role of psychosocial factors in ethnic differences in survival on dialysis in the Netherlands.
abstract: BACKGROUND
  Ethnic minority patients on dialysis are reported to have better survival rates relative to Caucasians. The reasons for this finding are not fully understood and European studies are scarce. This study examined whether ethnic differences in survival could be explained by patient characteristics, including psychosocial factors.
  
  
  METHODS
  We analysed data of the Netherlands Cooperative Study on the Adequacy of Dialysis study, an observational prospective cohort study of patients who started dialysis between 1997 and 2007 in the Netherlands. Ethnicity was classified as Caucasian, Black or Asian, assessed by local nurses. Data collected at the start of dialysis treatment included demographic, clinical and psychosocial characteristics. Psychosocial characteristics included data on health-related quality of life (HRQoL), mental health status and general health perception. Cox proportional hazards analysis was used to explore ethnic survival differences.
  
  
  RESULTS
  One thousand seven hundred and ninety-one patients were Caucasian, 45 Black and 108 Asian. The ethnic groups differed significantly in age, residual glomerular filtration rate, diabetes mellitus, erythropoietin use, plasma calcium, parathormone and creatinine, marital status and general health perception. No ethnic differences were found in HRQoL and mental health status. Crude hazard ratios (HRs) for mortality for Caucasians compared to Blacks and Asians were 3.1 [95% confidence interval (CI) 1.6-5.9] and 1.1 (95% CI 0.9-1.5), respectively. After adjustment for a range of potential explanatory variables, including psychosocial factors, the HRs were 2.5 (95% CI 1.2-4.9) compared with Blacks and 1.2 (95% CI 0.9-1.6) compared with Asians.
  
  
  CONCLUSIONS
  Although patient numbers were rather small, this study demonstrates, with 95% confidence, better survival for Black compared to Caucasian dialysis patients and equal survival for Asian compared to Caucasian dialysis patients in the Netherlands. This could not be explained by patient characteristics, including psychosocial factors.
authors: Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands. t.van_den_beukel@lumc.nl
authors: Tessa O
authors: TO
authors: van den Beukel
authors: Marion
authors: M
authors: Verduijn
authors: Saskia
authors: S
authors: le Cessie
authors: Kitty J
authors: KJ
authors: Jager
authors: Elisabeth W
authors: EW
authors: Boeschoten
authors: Raymond T
authors: RT
authors: Krediet
authors: Carl E H
authors: CE
authors: Siegert
authors: Adriaan
authors: A
authors: Honig
authors: Friedo W
authors: FW
authors: Dekker
mesh_terms: D044466:Asian People / Q000523:psychology; D044383:Black People / Q000523:psychology; D002423:Cause of Death; D003404:Creatinine / Q000097:blood; D005006:Ethnicity / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000401:mortality* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality* / Q000523:psychology*; D015996:Survival Rate; D044465:White People / Q000523:psychology
chemical_list: D003404:Creatinine