Racial disparities persist in home dialysis use across the US
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Following the 2011 Medicare prospective payment reform for dialysis services, racial disparities have persisted among patients using home dialysis in the U.S., according to a speaker at ASN Kidney Week.
“Prior research has also shown racial disparities in home dialysis, with lower use among black patients compared to white patients with kidney failure. The 2011 Medicare prospective payment reform for dialysis services modestly increased access to home dialysis treatment by way of both service availability by providers and patient utilization. But what remains unclear is whether these changes affected racial disparities in home dialysis use,” Virginia Wang, PhD, associate professor in the department of population health sciences at Duke University School of Medicine, said. “Our study objectives were to examine regional trends in home dialysis use in 2006 through 2016, among whites and non-whites.”
In a retrospective cohort study, researchers investigated dialysis facilities providing home dialysis to 1,098,579 patients with end-stage kidney disease between 2006 and 2016 in the U.S. Each health care region was defined as hospital referral regions (HRR), and “non-white” patients were defined as non-Hispanic Black/African American, Hispanic, non-Hispanic Asian or Pacific Islander, or other race/ethnicity.
To compare regional change in dialysis use by patient race, researchers divided counts of home dialysis users by white users of any dialysis modality, then repeated the process to evaluate rates for the comparison racial groups. These rates were then compared using a generalized estimating equation model with a negative binominal distribution, adjusting for regional ESKD provider and patient characteristic.
Analyses revealed the mean number of facilities providing home dialysis in each HRR rose from 15.6 in 2006 to 22.1 in 2016, with for-profit ownership (79.8% in 2006 and 87.1% in 2016) and chain affiliation (82.3% in 2006 and 91.7% in 2016) increasing over time. Researchers observed an increase in average regional home dialysis utilization rates over time, but also found white patients experienced consistently higher home dialysis use than patients in the racial comparison groups each year (19.5% vs. 12.9% in 2006, 26.2% vs. 17.8% in 2016, on average across HRRs).
“Racial disparities and regional home dialysis use did not change over time. Still, home dialysis use remained a third lower among non-whites before and after the 2011 payment reform for dialysis. Modest payment reforms do not appear to be sufficient levers to reduce historic health care disparities in home dialysis treatment. But another positive view is that racial disparities did not worsen,” Wang said. “More direct policy changes in American kidney care can help reduce racial disparities in home dialysis use and the data presented here may serve as a useful benchmark to observe these future changes.”
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Wang V, et al. Paper FR-OR21. Presented at: ASN Kidney Week; Nov. 4-7, 2021 (virtual meeting).
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