Receipt of renal replacement therapy in the United States: A population-based study of sociodemographic disparities from the Second National Health and Nutrition Examination Survey (NHANES II)

Neil R. Powe, Michelle E. Tarver-Carr, Mark S. Eberhardt, Frederick L. Brancati

Research output: Contribution to journalArticle

Abstract

Background: Persons with chronic kidney disease who need kidney replacement therapy to sustain life have health insurance. We examined whether young adults, women, blacks, less-educated persons, the poor, and persons residing in less populated areas receive treatment when health insurance is no longer a barrier. Methods: We conducted a case-control study nested in the Second National Health and Nutrition Examination Survey Mortality Study. Cases were persons treated with kidney replacement therapy determined by linkage to the end-stage renal disease treatment registry. Controls were untreated persons with kidney disease who died not appearing in the registry. Results: During 12 to 16 years, 44 persons developed treated disease, and 145 persons, untreated disease. After adjustment for sex, age, education, population of residential area, and comorbid conditions in logistic regression analysis, younger versus older age and living in a highly populated versus less populated area were both independently associated with treatment (relative odds of treatment, 5.57; 95% confidence interval, 1.72 to 18.0; and 4.33; 95% confidence interval, 2.09 to 8.97, respectively). Race, sex, education, and poverty were not associated with less treatment. Conclusion: We found no disparity in life-saving chronic kidney disease treatment with regard to race or socioeconomic status in this population-based study. Less receipt of treatment by older adults may reflect greater comorbid disease or choices made by persons or their providers. Strategies to render treatment in less populated areas, including incentives to deliver care to such areas, should be encouraged.

Original languageEnglish (US)
Pages (from-to)249-255
Number of pages7
JournalAmerican Journal of Kidney Diseases
Volume42
Issue number2
DOIs
StatePublished - Aug 1 2003
Externally publishedYes

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Renal Replacement Therapy
Nutrition Surveys
Population
Sex Education
Therapeutics
Health Insurance
Chronic Renal Insufficiency
Registries
Confidence Intervals
Kidney Diseases
Poverty
Social Class
Chronic Kidney Failure
Case-Control Studies
Motivation
Young Adult
Logistic Models
Odds Ratio
Regression Analysis
Mortality

Keywords

  • Access to care
  • African Americans
  • Chronic kidney disease (CKD)
  • Demographics
  • End-stage renal disease (ESRD)
  • Health insurance
  • Poverty
  • Socioeconomic status

ASJC Scopus subject areas

  • Nephrology

Cite this

Receipt of renal replacement therapy in the United States : A population-based study of sociodemographic disparities from the Second National Health and Nutrition Examination Survey (NHANES II). / Powe, Neil R.; Tarver-Carr, Michelle E.; Eberhardt, Mark S.; Brancati, Frederick L.

In: American Journal of Kidney Diseases, Vol. 42, No. 2, 01.08.2003, p. 249-255.

Research output: Contribution to journalArticle

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abstract = "Background: Persons with chronic kidney disease who need kidney replacement therapy to sustain life have health insurance. We examined whether young adults, women, blacks, less-educated persons, the poor, and persons residing in less populated areas receive treatment when health insurance is no longer a barrier. Methods: We conducted a case-control study nested in the Second National Health and Nutrition Examination Survey Mortality Study. Cases were persons treated with kidney replacement therapy determined by linkage to the end-stage renal disease treatment registry. Controls were untreated persons with kidney disease who died not appearing in the registry. Results: During 12 to 16 years, 44 persons developed treated disease, and 145 persons, untreated disease. After adjustment for sex, age, education, population of residential area, and comorbid conditions in logistic regression analysis, younger versus older age and living in a highly populated versus less populated area were both independently associated with treatment (relative odds of treatment, 5.57; 95{\%} confidence interval, 1.72 to 18.0; and 4.33; 95{\%} confidence interval, 2.09 to 8.97, respectively). Race, sex, education, and poverty were not associated with less treatment. Conclusion: We found no disparity in life-saving chronic kidney disease treatment with regard to race or socioeconomic status in this population-based study. Less receipt of treatment by older adults may reflect greater comorbid disease or choices made by persons or their providers. Strategies to render treatment in less populated areas, including incentives to deliver care to such areas, should be encouraged.",
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AB - Background: Persons with chronic kidney disease who need kidney replacement therapy to sustain life have health insurance. We examined whether young adults, women, blacks, less-educated persons, the poor, and persons residing in less populated areas receive treatment when health insurance is no longer a barrier. Methods: We conducted a case-control study nested in the Second National Health and Nutrition Examination Survey Mortality Study. Cases were persons treated with kidney replacement therapy determined by linkage to the end-stage renal disease treatment registry. Controls were untreated persons with kidney disease who died not appearing in the registry. Results: During 12 to 16 years, 44 persons developed treated disease, and 145 persons, untreated disease. After adjustment for sex, age, education, population of residential area, and comorbid conditions in logistic regression analysis, younger versus older age and living in a highly populated versus less populated area were both independently associated with treatment (relative odds of treatment, 5.57; 95% confidence interval, 1.72 to 18.0; and 4.33; 95% confidence interval, 2.09 to 8.97, respectively). Race, sex, education, and poverty were not associated with less treatment. Conclusion: We found no disparity in life-saving chronic kidney disease treatment with regard to race or socioeconomic status in this population-based study. Less receipt of treatment by older adults may reflect greater comorbid disease or choices made by persons or their providers. Strategies to render treatment in less populated areas, including incentives to deliver care to such areas, should be encouraged.

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