Affiliation:
1. Nephrology Service Walter Reed National Military Medical Center Bethesda MD
2. Uniformed Services University Bethesda MD
3. Department of Public Health Sciences University of Virginia School of Medicine Charlottesville VA
4. NIDDK National Institutes of Health Bethesda MD
5. Department of Medicine David Geffen School of Medicine at UCLA Los Angeles CA
Abstract
Background
Racial disparities in invasive cardiac procedures such as percutaneous coronary intervention (
PCI
) in the general population are well documented; however, national‐level data on such disparities in the end‐stage renal disease (
ESRD
) population are lacking. We assessed racial differences in
PCI
between black and white patients with
ESRD
on maintenance dialysis.
Methods and Results
Using the US Renal Data System database, we abstracted Medicare inpatient procedure claims for
PCI
in a cohort of 268 575 Medicare‐primary patients who initiated treatment on maintenance dialysis from January 1, 2009, through June 1, 2013. We conducted Cox regression analyses with
PCI
being the event, adjusted for demographic characteristics, Hispanic ethnicity, cause of
ESRD
, comorbidities, and socioeconomic factors. We also assessed the probability of
PCI
, accounting for death or transplant in competing risk regression models. The crude incidence rate of
PCI
among white patients was 25.8 per 1000 patient‐years versus 15.5 per 1000 patient‐years among black patients. Cox regression analyses demonstrated that black patients were significantly less likely to undergo
PCI
compared with white patients (adjusted hazard ratio: 0.64; 95%
CI
, 0.62–0.67;
P
<0.001). In the competing risk models, the racial gap for
PCI
among black and white patients remained significant with death (subdistribution hazard ratio: 0.81; 95%
CI
, 0.76–0.85;
P
<0.001) or transplant as a competing event (subdistribution hazard ratio: 0.67; 95%
CI,
0.64–0.70;
P
<0.001).
Conclusions
A racial gap exists in
PCI
use among dialysis patients despite having comprehensive coverage with Medicare. These findings persisted despite accounting for demographic, clinical, socioeconomic factors, and death or transplant as competing events.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
4 articles.
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