Abstract: SA-PO913
Racial Disparities in Percutaneous Coronary Intervention in the ESKD Population
Session Information
- Dialysis: Cardiovascular, BP, Volume
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Nee, Robert, Walter Reed National Military Medical Center, Bethesda, Maryland, United States
- Norris, Keith C., UCLA, Marina Del Rey, California, United States
- Yuan, Christina M., Walter Reed National Military Medical Center, Bethesda, Maryland, United States
- Agodoa, Lawrence, The National Institutes of Health, NIDDK, Bethesda, Maryland, United States
- Abbott, Kevin C., The National Institutes of Health, NIDDK, Bethesda, Maryland, United States
Background
Racial disparities in invasive cardiac procedures such as percutaneous coronary intervention (PCI) in the general population are well documented. However, contemporary national-level data on such disparities in the end-stage kidney disease (ESKD) population are lacking. Herein we assessed racial differences in the receipt of PCI between Blacks and Whites with ESKD, after the start of maintenance dialysis.
Methods
Using the US Renal Data System database, we abstracted Medicare inpatient procedure claims for PCI in a cohort of 269,984 Medicare primary patients who initiated on maintenance dialysis from 1 January 2009 through 1 June 2013, and followed until 31 December 2013. We conducted Cox regression analyses, adjusted for demographic characteristics, cause of ESKD, comorbidities, and socioeconomic factors (Medicare-Medicaid dual eligibility as a proxy measure of individual-level poverty, employment status, and ZIP code-level median household income obtained from the 2010 US Census). We also modeled death as a competing event in competing risk regression using the Fine and Gray method.
Results
The crude incidence rates of PCI among Whites were 32.9 per 1000 patient-years (PY) vs. Blacks 20.4 per 1000 PY, respectively [Figure 1]. Cox regression analyses demonstrated that Blacks were significantly less likely to undergo PCI compared to Whites (adjusted hazard ratio [aHR] 0.64, 95% CI 0.55-0.74, p<0.001). The aHR was similar in non-Hispanic Blacks vs. non-Hispanic Whites (aHR 0.62, 95% CI 0.53-0.73, p<0.001). In the competing risk model, the racial gap for PCI among Blacks and Whites narrowed but remained significant (subdistribution HR 0.73, 95% CI 0.62-0.88, p<0.001).
Conclusion
There exists a racial gap among incident dialysis patients undergoing PCI despite having comprehensive coverage with Medicare. These findings persisted despite accounting for demographic, clinical, socioeconomic factors and death as a competing risk.
Figure 1