Differences in Mortality Among Mexican-American, Puerto Rican, and Cuban-American Dialysis Patients in the United States

Diane L. Frankenfield, Sangeetha M. Krishnan, Valarie B. Ashby, Tempie H. Shearon, Michael V. Rocco, Rajiv Saran

Research output: Contribution to journalArticle

Abstract

Background: The Hispanic ethnic group is heterogeneous, with distinct genetic, cultural, and socioeconomic characteristics, but most prior studies of patients with end-stage renal disease focus on the overall Hispanic ethnic group without further granularity. We examined survival differences among Mexican-American, Puerto Rican, and Cuban-American dialysis patients in the United States. Study Design: Prospective observational study. Setting & Participants: Data from individuals randomly selected for the End-Stage Renal Disease Clinical Performance Measures Project (2001 to 2005) were examined. Mexican-American (n = 2,742), Puerto Rican (n = 838), Cuban-American (n = 145), and Hispanic-other dialysis patients (n = 942) were compared with each other and with non-Hispanic (n = 33,076) dialysis patients in the United States. Predictors: Patient characteristics of interest included ethnicity/race, comorbidities, and specific available laboratory values. Outcomes: The major outcome of interest was mortality. Results: In the fully adjusted multivariable model, 2-year mortality risk was significantly lower for the Mexican-American and Hispanic-other groups compared with non-Hispanics (adjusted hazard ratio, 0.79; 95% confidence interval, 0.73 to 0.85; adjusted hazard ratio, 0.81; 95% confidence interval, 0.71 to 0.92, respectively). Differences in 2-year mortality rates within the Hispanic ethnic groups were statistically significant (P = 0.004) and ranged from 21% lower mortality in Mexican Americans to 3% higher mortality in Puerto Ricans compared with non-Hispanics. Limitations: Include those inherent to an observational study, potential ethnic group misclassification, and small sample sizes for some Hispanic subgroups. Conclusion: Mexican-American and Hispanic-other dialysis patients have a survival advantage compared with non-Hispanics. Furthermore, Mexican Americans, Cuban Americans, and Hispanic others had a survival advantage compared with their Puerto Rican counterparts. Future research should continue to examine subgroups within Hispanic ethnicity to understand underlying reasons for observed differences that may be masked by examining the Hispanic ethnic group as only a single entity.

Original languageEnglish (US)
Pages (from-to)647-657
Number of pages11
JournalAmerican Journal of Kidney Diseases
Volume53
Issue number4
DOIs
StatePublished - Apr 2009

Fingerprint

Hispanic Americans
Dialysis
Mortality
Ethnic Groups
Chronic Kidney Failure
Observational Studies
Survival
Confidence Intervals
Cultural Characteristics
Sample Size
Comorbidity
Prospective Studies

Keywords

  • Cuban American
  • disparity
  • ethnicity
  • Hispanic
  • Mexican American
  • mortality
  • outcomes
  • Puerto Rican

ASJC Scopus subject areas

  • Nephrology

Cite this

Differences in Mortality Among Mexican-American, Puerto Rican, and Cuban-American Dialysis Patients in the United States. / Frankenfield, Diane L.; Krishnan, Sangeetha M.; Ashby, Valarie B.; Shearon, Tempie H.; Rocco, Michael V.; Saran, Rajiv.

In: American Journal of Kidney Diseases, Vol. 53, No. 4, 04.2009, p. 647-657.

Research output: Contribution to journalArticle

Frankenfield, Diane L. ; Krishnan, Sangeetha M. ; Ashby, Valarie B. ; Shearon, Tempie H. ; Rocco, Michael V. ; Saran, Rajiv. / Differences in Mortality Among Mexican-American, Puerto Rican, and Cuban-American Dialysis Patients in the United States. In: American Journal of Kidney Diseases. 2009 ; Vol. 53, No. 4. pp. 647-657.
@article{1c1a18fe206d4d1896108425915bb835,
title = "Differences in Mortality Among Mexican-American, Puerto Rican, and Cuban-American Dialysis Patients in the United States",
abstract = "Background: The Hispanic ethnic group is heterogeneous, with distinct genetic, cultural, and socioeconomic characteristics, but most prior studies of patients with end-stage renal disease focus on the overall Hispanic ethnic group without further granularity. We examined survival differences among Mexican-American, Puerto Rican, and Cuban-American dialysis patients in the United States. Study Design: Prospective observational study. Setting & Participants: Data from individuals randomly selected for the End-Stage Renal Disease Clinical Performance Measures Project (2001 to 2005) were examined. Mexican-American (n = 2,742), Puerto Rican (n = 838), Cuban-American (n = 145), and Hispanic-other dialysis patients (n = 942) were compared with each other and with non-Hispanic (n = 33,076) dialysis patients in the United States. Predictors: Patient characteristics of interest included ethnicity/race, comorbidities, and specific available laboratory values. Outcomes: The major outcome of interest was mortality. Results: In the fully adjusted multivariable model, 2-year mortality risk was significantly lower for the Mexican-American and Hispanic-other groups compared with non-Hispanics (adjusted hazard ratio, 0.79; 95{\%} confidence interval, 0.73 to 0.85; adjusted hazard ratio, 0.81; 95{\%} confidence interval, 0.71 to 0.92, respectively). Differences in 2-year mortality rates within the Hispanic ethnic groups were statistically significant (P = 0.004) and ranged from 21{\%} lower mortality in Mexican Americans to 3{\%} higher mortality in Puerto Ricans compared with non-Hispanics. Limitations: Include those inherent to an observational study, potential ethnic group misclassification, and small sample sizes for some Hispanic subgroups. Conclusion: Mexican-American and Hispanic-other dialysis patients have a survival advantage compared with non-Hispanics. Furthermore, Mexican Americans, Cuban Americans, and Hispanic others had a survival advantage compared with their Puerto Rican counterparts. Future research should continue to examine subgroups within Hispanic ethnicity to understand underlying reasons for observed differences that may be masked by examining the Hispanic ethnic group as only a single entity.",
keywords = "Cuban American, disparity, ethnicity, Hispanic, Mexican American, mortality, outcomes, Puerto Rican",
author = "Frankenfield, {Diane L.} and Krishnan, {Sangeetha M.} and Ashby, {Valarie B.} and Shearon, {Tempie H.} and Rocco, {Michael V.} and Rajiv Saran",
year = "2009",
month = "4",
doi = "10.1053/j.ajkd.2008.10.049",
language = "English (US)",
volume = "53",
pages = "647--657",
journal = "American Journal of Kidney Diseases",
issn = "0272-6386",
publisher = "W.B. Saunders Ltd",
number = "4",

}

TY - JOUR

T1 - Differences in Mortality Among Mexican-American, Puerto Rican, and Cuban-American Dialysis Patients in the United States

AU - Frankenfield, Diane L.

AU - Krishnan, Sangeetha M.

AU - Ashby, Valarie B.

AU - Shearon, Tempie H.

AU - Rocco, Michael V.

AU - Saran, Rajiv

PY - 2009/4

Y1 - 2009/4

N2 - Background: The Hispanic ethnic group is heterogeneous, with distinct genetic, cultural, and socioeconomic characteristics, but most prior studies of patients with end-stage renal disease focus on the overall Hispanic ethnic group without further granularity. We examined survival differences among Mexican-American, Puerto Rican, and Cuban-American dialysis patients in the United States. Study Design: Prospective observational study. Setting & Participants: Data from individuals randomly selected for the End-Stage Renal Disease Clinical Performance Measures Project (2001 to 2005) were examined. Mexican-American (n = 2,742), Puerto Rican (n = 838), Cuban-American (n = 145), and Hispanic-other dialysis patients (n = 942) were compared with each other and with non-Hispanic (n = 33,076) dialysis patients in the United States. Predictors: Patient characteristics of interest included ethnicity/race, comorbidities, and specific available laboratory values. Outcomes: The major outcome of interest was mortality. Results: In the fully adjusted multivariable model, 2-year mortality risk was significantly lower for the Mexican-American and Hispanic-other groups compared with non-Hispanics (adjusted hazard ratio, 0.79; 95% confidence interval, 0.73 to 0.85; adjusted hazard ratio, 0.81; 95% confidence interval, 0.71 to 0.92, respectively). Differences in 2-year mortality rates within the Hispanic ethnic groups were statistically significant (P = 0.004) and ranged from 21% lower mortality in Mexican Americans to 3% higher mortality in Puerto Ricans compared with non-Hispanics. Limitations: Include those inherent to an observational study, potential ethnic group misclassification, and small sample sizes for some Hispanic subgroups. Conclusion: Mexican-American and Hispanic-other dialysis patients have a survival advantage compared with non-Hispanics. Furthermore, Mexican Americans, Cuban Americans, and Hispanic others had a survival advantage compared with their Puerto Rican counterparts. Future research should continue to examine subgroups within Hispanic ethnicity to understand underlying reasons for observed differences that may be masked by examining the Hispanic ethnic group as only a single entity.

AB - Background: The Hispanic ethnic group is heterogeneous, with distinct genetic, cultural, and socioeconomic characteristics, but most prior studies of patients with end-stage renal disease focus on the overall Hispanic ethnic group without further granularity. We examined survival differences among Mexican-American, Puerto Rican, and Cuban-American dialysis patients in the United States. Study Design: Prospective observational study. Setting & Participants: Data from individuals randomly selected for the End-Stage Renal Disease Clinical Performance Measures Project (2001 to 2005) were examined. Mexican-American (n = 2,742), Puerto Rican (n = 838), Cuban-American (n = 145), and Hispanic-other dialysis patients (n = 942) were compared with each other and with non-Hispanic (n = 33,076) dialysis patients in the United States. Predictors: Patient characteristics of interest included ethnicity/race, comorbidities, and specific available laboratory values. Outcomes: The major outcome of interest was mortality. Results: In the fully adjusted multivariable model, 2-year mortality risk was significantly lower for the Mexican-American and Hispanic-other groups compared with non-Hispanics (adjusted hazard ratio, 0.79; 95% confidence interval, 0.73 to 0.85; adjusted hazard ratio, 0.81; 95% confidence interval, 0.71 to 0.92, respectively). Differences in 2-year mortality rates within the Hispanic ethnic groups were statistically significant (P = 0.004) and ranged from 21% lower mortality in Mexican Americans to 3% higher mortality in Puerto Ricans compared with non-Hispanics. Limitations: Include those inherent to an observational study, potential ethnic group misclassification, and small sample sizes for some Hispanic subgroups. Conclusion: Mexican-American and Hispanic-other dialysis patients have a survival advantage compared with non-Hispanics. Furthermore, Mexican Americans, Cuban Americans, and Hispanic others had a survival advantage compared with their Puerto Rican counterparts. Future research should continue to examine subgroups within Hispanic ethnicity to understand underlying reasons for observed differences that may be masked by examining the Hispanic ethnic group as only a single entity.

KW - Cuban American

KW - disparity

KW - ethnicity

KW - Hispanic

KW - Mexican American

KW - mortality

KW - outcomes

KW - Puerto Rican

UR - http://www.scopus.com/inward/record.url?scp=62749161458&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=62749161458&partnerID=8YFLogxK

U2 - 10.1053/j.ajkd.2008.10.049

DO - 10.1053/j.ajkd.2008.10.049

M3 - Article

VL - 53

SP - 647

EP - 657

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

SN - 0272-6386

IS - 4

ER -