Kidney Week

Abstract: TH-PO853

Intersection of Race, Age, and Mortality in Young Adults in the United States Renal Data System

Session Information

• Race, Ethnicity, and Gender in Kidney Health and Care
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diversity and Equity in Kidney Health

• 900 Diversity and Equity in Kidney Health

Authors

• Pottanat, Neha D., Indiana University School of Medicine, Indianapolis, Indiana, United States

Neha D. Pottanat, MD

• Laster, Marciana, Indiana University School of Medicine, Indianapolis, Indiana, United States

Marciana Laster, MD, MS

• Parulekar, Jaya S., Indiana University School of Medicine, Indianapolis, Indiana, United States

Jaya S. Parulekar, MD

• Di, Mengyu, Regenstrief Institute Inc, Indianapolis, Indiana, United States

Mengyu Di, MS

• Buford, Jade, Regenstrief Institute Inc, Indianapolis, Indiana, United States

Jade Buford, MPH

• Patzer, Rachel E., Indiana University School of Medicine, Indianapolis, Indiana, United States

Rachel E. Patzer, PhD, MPH

Background

Adults 18-44 years with end-stage kidney disease (ESKD) demonstrate heterogeneity in mortality and transplant waitlist access when categorized by race-ethnicity. Young adults have intensified disparities, but the age cut-off is unknown. Patients between 18-26 years experience changes in insurance status and executive functioning, as it relates to health self-management and transitioning to adult care. Our goal is to compare racial-ethnic disparities in adults <26 years to 26-44 years.

Methods

Incident patients receiving dialysis were identified using USRDS data from 2015-2020. Cox proportional hazard models adjusted for covariates were used to examine the relationship between race-ethnicity and mortality within each age category.

Results

Baseline characteristics of ESKD patients are described for each age category (Table 1). Non-Hispanic Black, non-Hispanic Asian, and Hispanic patients had a lower risk of mortality when compared to the reference group of non-Hispanic White patients in crude and adjusted analyses (Table 2). When stratified by age, these findings persisted amongst all racial-ethnic categories in patients 26-44 years old. However, in those <26 years, non-Hispanic Black patients had increased risk of mortality in crude analysis (HR 1.41, 95% CI 1.22-1.63) with attenuation upon adjustment. The lower risk of mortality noted in Hispanic and non-Hispanic Asian patients remained within this age group.

Conclusion

This study emphasizes that disparities in mortality within the non-Hispanic Black dialysis population are age dependent. This is consistent with prior research suggesting a "survival advantage" may not be present in younger non-Hispanic Black adults. Further research is needed to define critical ages when disparities in outcomes become apparent.