Lower Mortality for Older Blacks Receiving Dialysis

Blacks aged over 50 have lower mortality than whites; reverse is true for younger patients

TUESDAY, Aug. 9 (HealthDay News) -- Blacks older than 50 years who are undergoing dialysis have lower mortality compared to whites, as opposed to younger blacks who have an increased risk of death, according to a study published in the Aug. 10 issue of the Journal of the American Medical Association.

Lauren M. Kucirka, from the Johns Hopkins University School of Medicine in Baltimore, and colleagues assessed the impact of race on death among 1,330,007 patients undergoing dialysis for end-stage renal disease, accounting for age as an effect modifier and kidney transplantation as a competing risk. The median potential follow-up time was 6.7 years. Multivariate age-stratified Cox proportional hazards and competing risk models were used to analyze deaths in patients undergoing dialysis, and the main outcome measure was death in black patients versus white patients.

The investigators found a significantly lower death rate among black patients compared to whites (57.1 versus 63.5 percent mortality; adjusted hazard ratio [aHR], 0.84). After adjusting for age and kidney transplantation, black patients had higher mortality than whites at ages 18 to 30 years (27.6 versus 14.2 percent mortality; aHR, 1.93), at 31 to 40 years (37.4 versus 26.8 percent mortality; aHR, 1.46), and 41 to 50 years (44.8 versus 38.0 percent mortality; aHR, 1.12). Mortality rates were lower for blacks than for white patients at ages 51 to 60 years (51.5 versus 50.9 percent; aHR, 0.93), 61 to 70 years (64.9 versus 67.2 percent; aHR, 0.87), 71 to 80 years (76.1 versus 79.7 percent; aHR, 0.85), and older than 80 years (82.4 versus 83.6 percent; aHR, 0.87).

"Despite a survival advantage in older age groups, black patients younger than 50 years are at substantially increased risk of death as dialysis recipients," the authors write.

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