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Racial differences in choice of dialysis modality for children with end-stage renal disease
1Division of Pediatric Nephrology, Department of Pediatrics, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Insights
Black children with end-stage renal disease were more likely to receive hemodialysis than peritoneal dialysis compared to white children. This racial disparity in dialysis modality choice persisted after adjusting for various patient and facility factors.
Area of Science:
- Pediatric Nephrology
- Health Disparities Research
- Renal Replacement Therapy
Background:
- Racial disparities in medical service utilization are documented in adults but less so in pediatric populations.
- Understanding these disparities is crucial for equitable healthcare delivery.
- End-stage renal disease (ESRD) in children necessitates renal replacement therapy, with dialysis modality choice being a key decision.
Purpose of the Study:
- To investigate racial disparities in dialysis modality selection among children with end-stage renal disease.
- Specifically, to compare the likelihood of receiving hemodialysis versus peritoneal dialysis between Black and White children.
- To control for potential confounding factors influencing this choice.
Main Methods:
- A national cross-sectional study utilizing data from the Medicare ESRD registry in 1990.
- Included all Medicare-eligible children (age ≤19 years) undergoing chronic renal replacement therapy.
- Multiple logistic regression was used to analyze the odds of receiving hemodialysis versus peritoneal dialysis, adjusting for age, gender, ESRD cause/duration, socioeconomic factors, and facility characteristics.
Main Results:
- In 1990, 870 White and 368 Black children received chronic renal replacement therapy.
- Bivariate analysis showed Black children were twice as likely as White children to receive hemodialysis (OR, 2.2).
- Multivariate analysis confirmed Black children remained significantly more likely to receive hemodialysis (OR, 2.4) after adjustments.
Conclusions:
- Black race is strongly associated with a higher likelihood of receiving hemodialysis in children with end-stage renal disease.
- The observed disparity may be influenced by family, patient, or provider preferences.
- Further research is needed to elucidate the underlying causes of this racial difference in dialysis modality choice.
Objective:
Black-white disparities in the use of specific medical and surgical services have been reported in adult populations. Such disparities are not well documented in children. We sought to determine whether racial disparities in the use of medical services exist among children with chronic illness who have similar health insurance, specifically the choice of dialysis modality for individuals with end-stage renal disease.
Design:
National cross-sectional study.
Setting:
Outpatient dialysis facilities throughout the United States.
Patients And Participants:
All Medicare-eligible children (age,
Outcome Measures:
The odds of receiving hemodialysis versus peritoneal dialysis according to race. Adjustment was made for differences in age, gender, cause, and duration of end-stage renal disease, income, education, and facility characteristics using multiple logistic regression.
Results:
In 1990, 870 white and 368 black children received chronic (>1 year) renal replacement therapy in the United States. In bivariate analysis, blacks were two times (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.7, 2.8) more likely than whites to receive hemodialysis versus peritoneal dialysis. After controlling for other patient and facility characteristics in multivariate analysis, black children were still significantly more likely than white children to receive hemodialysis (OR, 2.4; 95% CI, 1.7, 3.5).
Conclusions:
Black race is strongly associated with the use of hemodialysis in children. Family, patient, or provider preferences could account for the difference in choice of therapy by race.