Factors linked with survival differences between Black, White kidney failure patients

Income inequality and residential segregation affect survival

2013-01-18

(Press-News.org) Highlights Residence in areas with higher average household income was linked with improved survival in kidney failure patients. In White patients, income inequality was associated with mortality. In Black patients exclusively, residence in highly segregated areas was associated with increased mortality.

More than 590,000 Americans in 2010 were treated for kidney failure.

Washington, DC (January 17, 2013) — Complex socioeconomic and residential factors may account for differences in survival between Black and White kidney failure patients, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The findings could help researchers design interventions to prolong patients' lives.

Among kidney failure patients on dialysis in the United States, Blacks tend to live longer than Whites with higher income. To investigate why, Paul Kimmel, MD (National Institutes of Diabetes and Digestive and Kidney Diseases, National Institutes of Health) and his colleagues examined links between income inequality and residence with Black and White kidney failure patients' survival.

For their study, the researchers merged US Renal Data System information on kidney failure patients starting dialysis from 2000 through 2008 with Census Bureau Black and White race-specific average household income. The analysis included 589,036 patients. Average household income for Black and White patients was $26,742 and $41,922, respectively.

Among the major findings: Residence in areas with higher average household income was linked with improved survival. In White patients, income inequality was associated with mortality. In Black patients exclusively, residence in highly segregated areas was associated with increased mortality.

The findings revealed that while Black kidney failure patients with lower incomes have longer survival than Whites, Blacks experience greater mortality as residential segregation increases. The results indicate that Black kidney failure patients on dialysis are particularly susceptible to both gradients in income and residential segregation.

"Unknown factors such as socioeconomic issues and neighborhood characteristics may affect differential survival for Black kidney failure patients," said Dr. Kimmel. "Lower access to inexpensive, nutritional foods and quality dialysis physicians and facilities, as well as living environments which are unsafe or predispose to physical inactivity could play roles and need to be evaluated." He noted that interventions directed at neighborhoods with a high proportion of Black residents might improve dialysis patient outcomes.

### Study co-authors include Chyng-Wen Fwu, DrPH (Social & Scientific Systems, Inc.) and Paul Eggers, PhD (National Institutes of Diabetes and Digestive and Kidney Diseases. National Institutes of Health)

Disclosures: The authors reported no financial disclosures.

The article, entitled "Segregation, Income Disparities and Survival in US Hemodialysis Patients," will appear online at http://jasn.asnjournals.org/ on January 17, 2013, doi: 10.1681/ASN.2012070659.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN), the National Institute of Diabetes, Digestive and Kidney Diseases, the National Institutes of Health, the Department of Health and Human Services, or the US Government. Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Founded in 1966, and with more than 13,500 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.

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