Racial/ethnic differences in mortality for dialysis patients in US territories and states

A recent analysis found differences in mortality rates for various racial/ethnic groups among patients undergoing dialysis in the U.S. territories vs. the 50 U.S. states. The findings, which appear in an upcoming issue of CJASN, point to the need for research into the causes of these disparities.

In the United States, mortality rates among patients with kidney failure who are treated with dialysis differ by racial/ethnic groups, but little is known about potential kidney disease-related disparities in the U.S. territories, namely Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa. The combined dialysis population of these territories exceeds that of over 27 U.S. states, with a disproportionately high rate of diabetes related kidney failure.

To investigate, Guofen Yan, Ph.D. (University of Virginia), Keith Norris, MD, Ph.D. (David Geffen School of Medicine at UCLA), and their colleagues examined information on 22,828 patients treated with dialysis in the 5 U.S. territories and 1,524,610 treated in the 50 U.S. states between 1995 and 2012.

The researchers found that the mortality rates were similar for Whites or Blacks in the territories compared with their counterparts with similar age and medical conditions in the states, and higher for Hispanics and Asians in the territories.

"To our knowledge, our study is the first to document important differences in dialysis mortality for various racial and ethnic groups in the U.S. territories vs. the U.S. 50 states," said Dr. Yan. "Although dialysis care should be similar everywhere, we found that Hispanic and Asian patients undergoing dialysis in the U.S. territories were more likely to die than their counterparts with similar age and medical conditions living in the 50 United States. Now that we know this, our next question to answer is, why?" Reasons could include dietary patterns, health behaviors, access to care, quality of care, insurance status, health care system factors, underlying illness, and biologic and genetic factors.

A Patient Voice editorial accompanies the study.