title: Neighborhood socioeconomic status, race, and mortality in young adult dialysis patients.
abstract: Young blacks receiving dialysis have an increased risk of death compared with whites in the United States. Factors influencing this disparity among the young adult dialysis population have not been well explored. Our study examined the relation of neighborhood socioeconomic status (SES) and racial differences in mortality in United States young adults receiving dialysis. We merged US Renal Data System patient-level data from 11,027 black and white patients ages 18-30 years old initiating dialysis between 2006 and 2009 with US Census data to obtain neighborhood poverty information for each patient. We defined low SES neighborhoods as those neighborhoods in U.S. Census zip codes with ≥20% of residents living below the federal poverty level and quantified race differences in mortality risk by level of neighborhood SES. Among patients residing in low SES neighborhoods, blacks had greater mortality than whites after adjusting for baseline demographics, clinical characteristics, rurality, and access to care factors. This difference in mortality between blacks and whites was significantly attenuated in higher SES neighborhoods. In the United States, survival between young adult blacks and whites receiving dialysis differs by neighborhood SES. Additional studies are needed to identify modifiable factors contributing to the greater mortality among young adult black dialysis patients residing in low SES neighborhoods.
authors.affiliation: Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York; tjohns@montefiore.org.
authors.forename: Tanya S
authors.initials: TS
authors.lastname: Johns
authors.affiliation: Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland;
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Estrella
authors.affiliation: Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland;
authors.forename: Deidra C
authors.initials: DC
authors.lastname: Crews
authors.affiliation: Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland;
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Appel
authors.affiliation: Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; Division of Preventive Medicine, Department of Family and Preventive Medicine, University of California San Diego School of Medicine, San Diego, California; and.
authors.forename: Cheryl A M
authors.initials: CA
authors.lastname: Anderson
authors.affiliation: Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
authors.forename: Patti L
authors.initials: PL
authors.lastname: Ephraim
authors.affiliation: Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland;
authors.forename: Courtney
authors.initials: C
authors.lastname: Cook
authors.affiliation: Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
authors.forename: L Ebony
authors.initials: LE
authors.lastname: Boulware
mesh_terms: D000293:Adolescent; D000328:Adult; D044383:Black People / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000208:ethnology* / Q000401:mortality* / Q000628:therapy; D008297:Male; D015995:Prevalence; D012042:Registries / Q000706:statistics & numerical data; D006435:Renal Dialysis / Q000401:mortality*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult; D001741:Black or African American