Receiving dialysis in primarily Black communities linked to worse outcomes for Black men
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Study findings show Black men who receive hemodialysis in communities with a higher proportion of Black residents experience worse outcomes than those who receive treatments in communities with fewer Black residents.
These worse outcomes include higher rates of hospitalization and mortality.
“It has been suggested that community-level factors that reflect inequities in the social determinants of health are important considerations; however, it is unclear whether place or personal factors play the more prominent role in these outcomes,” Ladan Golestaneh, MD, of the Albert Einstein College of Medicine/Montefiore Medical Center in the Bronx, and colleagues wrote. “The evidence linking place and health status is mixed, and there are conflicting theories with regard to the role of community on outcomes.”
For the study, researchers linked data from the U.S. Dialysis Outcomes and Practice Patterns Study with the American Community Survey and considered dialysis facility ZIP codes. Communities were categorized as having a higher or lower proportion of Black residents (30% or <30%, with 45% of men in the study receiving dialysis in higher percentage areas).
“By focusing on Black men, we also aim[ed] to understand the role of place on [end-stage kidney disease] ESKD health disparities in a group of U.S. citizens on whom structural racism is levied most harshly and to eliminate consideration of drivers of outcomes attributed to differences across individual race and sex,” the researchers wrote.
Results showed Black men who received hemodialysis in places with more Black residents had fewer comorbidities, with lower Charlson comorbidity scores than those who received dialysis in places with fewer Black residents (4 vs 5). These men also had lower arteriovenous fistula use (52.7% vs. 61.2%), fewer prescriptions for calcimimetics (25.2% vs. 35%) and shorter prescribed dialysis duration (657 vs. 693 minutes per week).
Researchers further observed that Black men who received dialysis in communities with a greater proportion of Black residents had higher adjusted hospitalization rates and mortality (per 10% increase of Black residents: incidence rate ratio of 1.09 and hazard ratio of 1.29, respectively)
“Despite on average being healthier and exhibiting equivalent adherence, our study showed that Black men receiving hemodialysis in communities with sizable numbers of Black residents had a higher adjusted risk for hospitalization and mortality,” Golestaneh and colleagues concluded. “To effectuate meaningful health care policy and impact on health care disparities and to optimize minority health overall, future research should focus the impact of community level factors to better understand, and policies to address, the inequities in the social determinants of health that directly and indirectly impact the quality of, and access to, health care experienced by persons receiving hemodialysis.”
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