Younger black patients have a higher risk of infection mortality that is mostly non-dialysis related: A national study of cause-specific mortality among U.S. maintenance dialysis patients - PubMed (original) (raw)

. 2017 Apr;21(2):232-242.

doi: 10.1111/hdi.12469. Epub 2016 Aug 18.

Affiliations

Alison J Yu et al. Hemodial Int. 2017 Apr.

Abstract

Introduction: While it has been well documented that in the U.S., black and Hispanic dialysis patients have overall lower risks of death than white dialysis patients, little is known whether their lower risks are observed in cause-specific deaths. Additionally, recent research reported that younger black patients have a higher risk of death, but the source is unclear. Therefore, this study examined cause-specific deaths among US dialysis patients by race/ethnicity and age.

Methods: This national study included 1,255,640 incident dialysis patients between 1995 and 2010 in the United States Renal Data System. Five cause-specific mortality rates, including cardiovascular (CVD), infection, malignancy, other known causes (miscellaneous), and unknown, were compared across blacks, Hispanics, and whites overall and stratified by age groups.

Findings: After multiple adjustments, Hispanic patients had the lowest risk of mortality for every major cause in almost all ages. Compared with whites, blacks had a lower risk of death from CVD, malignancy and miscellaneous causes in most age groups, but not from infection. In fact, blacks had a higher risk of infection death than whites in ages 18-30 years (HR [95% CI] 1.94 [1.69-2.23]; P < 0.001), 31-40 years (HR 1.51 [1.40-1.63]; P < 0.001) and 41-50 years (HR 1.07 [1.02-1.12]; P = 0.009), which were partially attributed to their higher prevalence of AIDS nephropathy. For each race/ethnicity, more than two-thirds of infection deaths were due to non-dialysis related infections.

Discussion: Hispanics had the lowest risk for each major cause of death. Blacks were less likely to die than whites from most causes, except infection. The previously reported higher overall mortality rate for younger blacks is attributed to their two-fold higher infection mortality, which is mostly non-dialysis related, suggesting a new direction to improve their overall health status. Research is greatly needed to determine social and biological factors that account for the survival gap in dialysis among different racial/ethnic groups.

Keywords: Cardiovascular; USRDS; dialysis related infection; non-dialysis related infection; racial/ethnic differences.

© 2016 International Society for Hemodialysis.

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Figures

Figure 1

Figure 1. Adjusted hazard ratios of death for blacks and Hispanics compared with whites by age group for all-cause and 5 major causes of death

The error bars represent 95% confidence intervals. The hazard ratios were adjusted for the following covariates: age, sex, employment, insurance at ESRD onset, body mass index, estimated GFR, 5 categories of ESRD cause (diabetes, hypertension, GN, others, and unknown), and presence of comorbid conditions (hypertension, diabetes, cardiac failure, atherosclerotic heart disease, other cardiac disease, cerebrovascular disease, peripheral vascular disease, chronic obstructive pulmonary disease, and cancer), immobility, lifestyle behaviors (smoking, alcohol, and drug dependence), dialysis modality, pre-ESRD use of erythropoiesis-stimulating agents, year of ESRD onset, and census regions (Northeast, Midwest, South, and West).

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