TY - JOUR
T1 - Receipt of renal replacement therapy in the United States
T2 - A population-based study of sociodemographic disparities from the Second National Health and Nutrition Examination Survey (NHANES II)
AU - Powe, Neil R.
AU - Tarver-Carr, Michelle E.
AU - Eberhardt, Mark S.
AU - Brancati, Frederick L.
N1 - Funding Information:
Supported in part by grant no. 500-92-0021 from the Health Care Financing Administration; grant no. 9930313 from the National Center for Health Statistics, grant no. K24 DK02643 from the National Institute of Diabetes and Digestive and Kidney Diseases (N.R.P.), grant no. DK53959 supplement for Underrepresented Minority Graduate Research Assistants from The National Institute of Health, National Institute of Diabetes and Digestive and Kidney Diseases (M.E.T-C.), and grant no. F31GM20081 from the National Research Service Award Minority predoctoral fellowship program (M.E.T-C.).
PY - 2003/8/1
Y1 - 2003/8/1
N2 - 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.
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.
KW - Access to care
KW - African Americans
KW - Chronic kidney disease (CKD)
KW - Demographics
KW - End-stage renal disease (ESRD)
KW - Health insurance
KW - Poverty
KW - Socioeconomic status
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U2 - 10.1016/S0272-6386(03)00649-8
DO - 10.1016/S0272-6386(03)00649-8
M3 - Article
C2 - 12900805
AN - SCOPUS:0041626089
SN - 0272-6386
VL - 42
SP - 249
EP - 255
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 2
ER -