title: Variations in outcomes of hemodialysis vascular access by race/ethnicity in the elderly.
abstract: OBJECTIVE
  Prevalence of end-stage renal disease, modality of treatment, and type of hemodialysis vascular access used varies widely by race/ethnicity in the United States, but outcomes of hemodialysis vascular access by race/ethnicity are poorly described. The objective of this study is to evaluate variations in outcomes of hemodialysis vascular access in the elderly by race/ethnicity.
  
  
  METHODS
  Medicare outpatient, inpatient, and carrier files were queried from 2006 to 2011 for beneficiaries that were age ≥66 years and dialysis-dependent at time of index fistula/graft creation, qualified for Medicare by age only, and were continuously enrolled in Medicare 12 months before and after index fistula/graft creation. Primary outcome measures were early vascular access failure and 12-month failure-free survival, specifically, the variation in the difference between fistula and graft in non-White vs White race/ethnicity groups.
  
  
  RESULTS
  Fistulas comprised a smaller proportion of index procedures performed in Blacks (65.9%; P < .001) and Asians (71.4%; P < .001), compared with Whites (78.0%) with no difference in Hispanics (78.7%; P = .59). Incidence of early failure after graft vs fistula was Whites, 34.9% vs 43.5% (P < .001), Blacks, 32.9% vs 49.1% (P < .001), Asians, 30.8% vs 40.5% (P = .014), and Hispanics 35.2% vs 43.2% (P = .005). The difference in early failure after fistula vs graft in Blacks was significantly larger than the difference in Whites (P < .001). The 12-month failure-free survival after index graft vs fistula was Whites 41.9% vs 38.9% (P = .008), Blacks 48.5% vs 37.3% (P < .001), Asians 51.6% vs 45.2% (P = .98), and Hispanics 51.9% vs 42.2% (P < .001). The difference in 12-month failure-free survival after graft vs fistula in Blacks and in Hispanics was larger than the difference in Whites (P < .001 and P = .02, respectively).
  
  
  CONCLUSIONS
  Outcomes of fistulas vs grafts in the elderly vary significantly by race/ethnicity. The decreased risk of early failure after graft vs fistula creation is larger in Blacks compared with Whites. The higher failure-free survival at 12 months after graft vs fistula creation is larger in Blacks compared with Whites and trends toward being larger in Hispanics compared with Whites.
authors.affiliation: Division of Vascular Surgery, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Calif. Electronic address: kwoo@mednet.ucla.edu.
authors.forename: Karen
authors.initials: K
authors.lastname: Woo
authors.affiliation: Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, Calif.
authors.forename: Laura
authors.initials: L
authors.lastname: Gascue
authors.affiliation: School of Pharmacy, University of Southern California, Los Angeles, Calif; Sol Price School of Public Policy, University of Southern California, Los Angeles, Calif.
authors.forename: Dana P
authors.initials: DP
authors.lastname: Goldman
authors.affiliation: Sol Price School of Public Policy, University of Southern California, Los Angeles, Calif.
authors.forename: John A
authors.initials: JA
authors.lastname: Romley
mesh_terms: D001741:Black or African American; D000367:Age Factors; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000639:trends; D001213:Asian; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000639:trends; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000208:ethnology; D006630:Hispanic or Latino; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy*; D008297:Male; D006278:Medicare; D006435:Renal Dialysis / Q000009:adverse effects / Q000639:trends; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D014481:United States / Q000453:epidemiology; D044465:White People