Medicare's end-stage renal disease program seems to have reduced outcome disparities among dialysis patients
Research Activities, August 2009, No. 348
Medicare's end-stage renal disease (ESRD) program seems to have eliminated income-based mortality differences among patients receiving hemodialysis, suggests a new study. This has resulted in similar adjusted survival for hemodialysis patients who reside in lower-, middle-, and higher-income areas.
Duke Clinical Research Institute investigators, led by Eric L. Eisenstein, D.B.A., evaluated relationships between lower- and higher-income versus middle-income area residence and mortality up to 5 years for 186,424 adults with ESRD. These patients began hemodialysis at stand-alone facilities between 1996 and 1999. Hemodialysis patients who resided in lower- versus higher-income areas had lower unadjusted mortality rates, were younger, and more often black.
After adjustment for other factors affecting ESRD survival, such as clinical factors and dialysis facility, there were no mortality differences among groups at different income levels. However, blacks in all income level groups had 23, 25, and 19 percent lower adjusted mortality rates than others in the lower-income, middle-income, and higher-income groups, respectively. These results demonstrate the need to fully adjust for patient characteristics and the risks of using race as a surrogate for socioeconomic status, caution the researchers. Their study was supported by the Agency for Healthcare Research and Quality (HS13345).
See "Do income level and race influence survival in patients receiving hemodialysis?" by Dr. Eisenstein, Jie L. Sun, M.S., Kevin J. Anstrom, Ph.D., and others, in the February 2009 American Journal of Medicine 122(2), pp. 170-180.