Disparities Affect Dialysis Patients
Race and Gender Differences May Influence Quality of Care
Feb. 25, 2003 -- The overall quality of care for people who undergo dialysis for kidney failure may be improving, but those improvements still haven't been enough to completely eliminate racial and gender disparities in care. A new study shows men and whites continue to fare better and receive higher quality hemodialysis care than blacks and women, but these differences are narrowing.
Hemodialysis is a process used to clean the blood of impurities and byproducts in patients with kidney failure.
According to researchers, race and sex disparities in health outcomes of kidney failure patients has been widely documented, but little is known about whether recent efforts to improve the quality of care these patients receive has had any impact in reducing these gaps.
The study, published in the Feb. 26 issue of The Journal of the American Medical Association, found that improvements in health outcomes such as nutritional status, anemia, and adequacy of dialysis have had an impact on these disparities, and although they have improved the overall quality of care for most dialysis patients, gaps between sex and race still exist.
Researchers looked at information from 58,7000 hemodialysis patients who were treated between 1993 and 2000 as part of The Centers for Medicare and Medicaid Services quality improvement project. They looked at three major indicators of treatment success, including changes in the hemodialysis dose, anemia management (keeping hemoglobin levels in the blood at healthy levels), and nutritional status.
The study found that the number of patients who received an adequate hemodialysis dose rose from 46% of white patients and 36% of black patients in 1993 to 87% and 84%, respectively, in 2000. Those findings mean the gap between black and white patients was reduced from 10% to 3% for this indicator.
With regard to sex, adequate hemodialysis dose in women rose from 54% to 90% and in men rose from 31% to 82% between 1993 and 2000. The gap between female and male patients fell from 23% to 9%.
"The reduction in race and sex gaps in hemodialysis dose suggests that quality improvement efforts may reduce disparities," writes researcher Ashwini R. Sehgal, MD, of the MetroHealth Medical Center in Cleveland, and colleagues.
However, researchers say sizeable gaps were still present in 2000, and those disparities didn't change significantly in other areas related to anemia and nutrition (although the proportion of all patients with adequate hemoglobin levels did increase threefold from 26% to 74% from 1993 to 2000).
In an editorial that accompanies the study, Kaytura Felix Aaron, MD, and Carolyn M. Clancy, MD, of the Agency for Healthcare Research and Quality in Rockville, Md., say the study raises a crucial question about whether efforts to improve overall quality of care for dialysis patients can simultaneously reduce race and ethnic disparities.
According to this study, they say that answer may be yes but the results may be inconsistent.
"The rising tide of quality improvement may lead to improvements for all patients," write the editorialists. "But failure to examine the distribution of benefits may also wash away undiscovered information about the intersections of disease, individual characteristics, and health care delivery that are essential for eliminating disparities in health care and continuing to develop effective treatments."
SOURCE: The Journal of the American Medical Association, Feb. 26, 2003.