title: Trends in relative mortality between Hispanic and non-Hispanic whites initiating dialysis: a retrospective study of the US Renal Data System.
abstract: BACKGROUND
  Hispanic patients undergoing long-term dialysis experience better survival compared with non-Hispanic whites. It is unknown whether this association differs by age, has changed over time, or is due to differential access to kidney transplantation.
  
  
  METHODS
  National retrospective cohort study.
  
  
  METHODS
  Using the US Renal Data System, we identified 615,618 white patients 18 years or older who initiated dialysis therapy between January 1, 1995, and December 31, 2007.
  
  
  METHODS
  Hispanic ethnicity (vs non-Hispanic whites), year of end-stage renal disease incidence, age (as potential effect modifier).
  
  
  RESULTS
  All-cause and cause-specific mortality.
  
  
  RESULTS
  We found that Hispanics initiating dialysis therapy experienced lower mortality, but age modified this association (P < 0.001). Compared with non-Hispanic whites, mortality in Hispanics was 33% lower at ages 18-39 years (adjusted cause-specific HR [HRcs], 0.67; 95% CI, 0.64-0.71) and 40-59 years (HRcs, 0.67; 95% CI, 0.66-0.68), 19% lower at ages 60-79 years (HRcs, 0.81; 95% CI, 0.80-0.82), and 6% lower at 80 years or older (HRcs, 0.94; 95% CI, 0.91-0.97). Accounting for the differential rates of kidney transplantation, the associations were attenuated markedly in the younger age strata; the survival benefit for Hispanics was reduced from 33% to 10% at ages 18-39 years (adjusted subdistribution-specific HR [HRsd], 0.90; 95% CI, 0.85-0.94) and from 33% to 19% among those aged 40-59 years (HRsd, 0.81; 95% CI, 0.80-0.83).
  
  
  CONCLUSIONS
  Inability to analyze Hispanic subgroups that may experience heterogeneous mortality outcomes.
  
  
  CONCLUSIONS
  Overall, Hispanics experienced lower mortality, but differential access to kidney transplantation was responsible for much of the apparent survival benefit noted in younger Hispanics.
authors: Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA. cmarce01@stanford.edu
authors: Cristina M
authors: CM
authors: Arce
authors: Benjamin A
authors: BA
authors: Goldstein
authors: Aya A
authors: AA
authors: Mitani
authors: Wolfgang C
authors: WC
authors: Winkelmayer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D014480:United Nations; D044465:White People; D055815:Young Adult
keywords: Clinical epidemiology; Hispanic ethnicity; dialysis; survival
references: J Am Soc Nephrol. 2012 Jun;23(6):1078-85
references: 22518002
references: J Am Soc Nephrol. 1998 Nov;9(11):2142-7
references: 9808103
references: Soc Sci Q. 2000;81(1):459-76
references: 17879490
references: Am J Kidney Dis. 2011 Aug;58(2):214-27
references: 21705121
references: Kidney Int. 2000 Sep;58(3):1293-9
references: 10972693
references: J Natl Cancer Inst Monogr. 1995;(18):11-5
references: 8562210
references: Stat Med. 2008 Nov 29;27(27):5709-24
references: 18712779
references: Clin J Am Soc Nephrol. 2011 Aug;6(8):1858-65
references: 21784835
references: Ethn Dis. 2001 Autumn;11(3):496-518
references: 11572416
references: Am J Cardiol. 2003 Nov 15;92(10):1198-200
references: 14609596
references: Am J Kidney Dis. 2002 Mar;39(3):445-59
references: 11877563
references: Am J Kidney Dis. 1994 Jun;23(6):803-7
references: 8203362
references: J Am Soc Nephrol. 2000 Dec;11(12):2351-2357
references: 11095658
references: Demography. 2004 Aug;41(3):385-415
references: 15461007
references: Kidney Int. 1999 Jun;55(6):2515-23
references: 10354301
references: Stroke. 2012 May;43(5):1224-9
references: 22357712
references: Am J Kidney Dis. 2002 Dec;40(6):1153-61
references: 12460033
references: Stat Methods Med Res. 2007 Jun;16(3):219-42
references: 17621469
references: Am J Kidney Dis. 2009 Apr;53(4):647-57
references: 19150157
references: JAMA. 2003 Jul 9;290(2):199-206
references: 12851274
references: Am J Kidney Dis. 2003 Feb;41(2):310-8
references: 12552491
references: Kidney Int. 2006 May;69(9):1675-82
references: 16572114
references: Diabetes Care. 2004 May;27(5):1115-20
references: 15111530
references: Semin Dial. 2007 Nov-Dec;20(6):577-85
references: 17991208
references: JAMA. 2011 Aug 10;306(6):620-6
references: 21828325
references: J Am Soc Nephrol. 2005 Jan;16(1):180-8
references: 15563563
references: Clin J Am Soc Nephrol. 2011 Sep;6(9):2121-31
references: 21896829
references: J Am Soc Nephrol. 2011 Apr;22(4):743-51
references: 21372209
references: Ann N Y Acad Sci. 2001 Dec;954:140-74
references: 11797855
references: J Am Soc Nephrol. 2005 Mar;16(3):782-90
references: 15677309
references: Am J Kidney Dis. 2006 Nov;48(5):720-6
references: 17059991
references: J Am Soc Nephrol. 2000 Mar;11(3):520-529
references: 10703676
references: Am J Kidney Dis. 1996 Aug;28(2):226-34
references: 8768918
references: Am J Kidney Dis. 2004 Aug;44(2):344-52
references: 15264194
references: Clin J Am Soc Nephrol. 2010 Nov;5(11):2046-52
references: 20688886
references: J Am Soc Nephrol. 2007 Sep;18(9):2575-82
references: 17656476
references: Am J Public Health. 1999 Oct;89(10):1543-8
references: 10511837
references: Hypertension. 2004 Apr;43(4):775-9
references: 14981073
references: Am J Kidney Dis. 2010 Nov;56(5):928-36
references: 20888100
references: J Am Soc Nephrol. 2005 Dec;16(12):3711-20
references: 16236803
references: J Am Soc Nephrol. 2006 Oct;17(10):2892-9
references: 16959827
references: J Am Soc Nephrol. 2006 Oct;17(10):2910-8
references: 16988065
references: J Am Soc Nephrol. 2003 Jan;14(1):180-6
references: 12506150
references: Am J Kidney Dis. 2013 Jan;61(1 Suppl 1):A7, e1-476
references: 23253259
references: Clin J Am Soc Nephrol. 2012 Feb;7(2):289-96
references: 22114148
references: Am J Cardiol. 1998 Feb 15;81(4):412-7
references: 9485129
references: J Am Soc Nephrol. 1999 Mar;10(3):610-9
references: 10073612
references: JAMA. 1993 Nov 24;270(20):2464-8
references: 8031341