title: Effect of race and insurance status on outcomes after vascular access placement for hemodialysis.
abstract: BACKGROUND
  Race and insurance status are seen as potential barriers to health care access and maintenance. Our goal was to see how these, as well as other patient and procedural characteristics, affected our populations' upper extremity vascular access outcomes.
  
  
  METHODS
  We retrospectively reviewed 601 vascular access patients from 2004 through 2012 in our urban university hospital. We recorded patient demographics, insurance status, comorbidities, and complications. Primary outcomes were reintervention, long-term mortality, and transplantation.
  
  
  RESULTS
  Median age was 62 ± 15.8 years, and 58% were male. Most operations were arteriovenous fistulas (66%). The majority of patients identified themselves as Hispanic (50%), followed by white (22%), and black (19%). Most patients had Medicare only (42%), 31% had private insurance, and 27% had Medicaid as their insurance. Black/African American patients were more likely to receive an arteriovenous graft (AVG) compared with white and Hispanic patients (44% vs. 28% and 33%, P < 0.05). White patients were significantly older (68) than Hispanics (61) or blacks (58). Freedom from reintervention at 5 years was 55% with previous tunneled catheter use predictive. Mortality at 5 years was 35% and predicted by age, AVG placement, white race, and not receiving a kidney transplant. Predictors of not receiving a transplant included older age, lower albumin, AVG placement, and coronary artery disease.
  
  
  CONCLUSIONS
  There were no disparities with insurance status in long-term outcomes in our population. Race was not a factor for reintervention or transplantation; however, black/African American patients were more likely have an AVG placed, and white patients had a lower long-term survival after access placement.
authors.affiliation: New York-Presbyterian Hospital, College of Physicians and Surgeons, Columbia University, New York, NY. Electronic address: jes9061@nyp.org.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Siracuse
authors.affiliation: New York-Presbyterian Hospital, College of Physicians and Surgeons, Columbia University, New York, NY.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Gill
authors.affiliation: New York-Presbyterian Hospital, College of Physicians and Surgeons, Columbia University, New York, NY.
authors.forename: Irene
authors.initials: I
authors.lastname: Epelboym
authors.affiliation: New York-Presbyterian Hospital, College of Physicians and Surgeons, Columbia University, New York, NY.
authors.forename: Adi
authors.initials: A
authors.lastname: Wollstein
authors.affiliation: New York-Presbyterian Hospital, College of Physicians and Surgeons, Columbia University, New York, NY.
authors.forename: Yuriy
authors.initials: Y
authors.lastname: Kotsurovskyy
authors.affiliation: New York-Presbyterian Hospital, College of Physicians and Surgeons, Columbia University, New York, NY.
authors.forename: Diana
authors.initials: D
authors.lastname: Catz
authors.affiliation: New York-Presbyterian Hospital, College of Physicians and Surgeons, Columbia University, New York, NY.
authors.forename: In-Kyong
authors.initials: IK
authors.lastname: Kim
authors.affiliation: New York-Presbyterian Hospital, College of Physicians and Surgeons, Columbia University, New York, NY.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Morrissey
mesh_terms: D000367:Age Factors; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D002405:Catheterization, Central Venous; D015897:Comorbidity; D005260:Female; D006297:Health Services Accessibility / Q000191:economics; D054624:Health Status Disparities; D006785:Hospitals, University; D006801:Humans; D019458:Insurance Coverage / Q000191:economics; D007348:Insurance, Health / Q000191:economics; D016030:Kidney Transplantation; D008297:Male; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D017149:Private Sector; D044469:Racial Groups; D006435:Renal Dialysis / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D034941:Upper Extremity / Q000098:blood supply*; D014504:Urban Health