Study: Racial gaps in home dialysis persist despite Medicare intervention
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Key takeaways:
- Regional rates of home dialysis were about one-third lower for patients who were not white compared with white patients.
- Racial disparities in home dialysis use did not improve from 2011 to 2016.
Racial gaps in home dialysis treatment still exist among patients with kidney disease, even after Medicare introduced a new payment structure to alleviate critical barriers to care, according to results of a recently published study. Congress approved the Medicare End-Stage Renal Disease prospective payment system (PPS) in 2011 to control costs and increase access to home peritoneal dialysis and hemodialysis (HHD). But despite modest increases seen in dialysis availability and patient utilization following the reform, “significant racial disparities in home dialysis remain,” Virginia Wang, PhD, faculty at the Duke University School of Medicine and lead research author, wrote in the study.
In the retrospective cohort study of home-care dialysis facilities, researchers analyzed data for 1,098,579 patients with prevalent end-stage kidney disease from 2006 to 2016. To determine potential disparities among racial groups, investigators compared hospital referral region (HRR) utilization rates of home dialysis between white patients and patients who were not white using a generalized estimating equation with a negative binomial distribution adjusting for varying regional characteristics.
Regional rates of home dialysis were about one-third lower for patients who were not white compared with white patients. Image: Adobe Stock.
In 2006, the mean number of facilities offering home dialysis in each HRR was 15.6. Researchers found the mean number increased to 22.1 in 2016, and observed mean HRR home dialysis rates increased overall.
The prevalence of patients with ESKD who received PD in HRRs also increased from a mean 75.1 patients per 1,000 in 2006 to 91 per 1,000 in 2016. Overall, 51.2% of patients were white compared with 31.2% who were Black, 12% who were Hispanic, 4% who were Asian or Pacific Islander and 1.6% of patients were another race or race was unknown.
“Racial disparities in home dialysis use that existed years before the 2011 dialysis payment reform did not improve in the five years that followed,” according to the researchers.
“In adjusted analysis, there was no evidence of changes in observed disparities between white and non-white patients in HRR home dialysis utilization over time,” they wrote. “Similarly, there was no difference in HRR-level disparities in HRR home dialysis use before vs. after the implementation of the Medicare ESKD PPS in 2011.”
Continued “racial disparities observed in home dialysis use over time suggest that the presence of clinical, as well as nonclinical factors, may be driving differences in uptake of home dialysis,” according to the researchers, and although half of all then-patients with kidney failure were not white, the study shows regional rates of home dialysis were about one-third lower for patients who were not white, comparatively.
“Our findings highlight an important and attainable goal in improving U.S. kidney care: increasing uptake of home dialysis for all patients and reducing disparities,” the researchers wrote.
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