Delayed referral of black, Hispanic, and older patients with chronic renal failure

Ifudu, Onyekachi; Dawood, Mohammed Radef; Iofel, Yakov; Valcourt, Jean S.; Friedman, Eli A.

doi:10.1016/s0272-6386(99)70226-x

Cited by 94 publications

(65 citation statements)

References 23 publications

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“…The majority of participants (66%) had mild symptoms (≤ 7), with moderate symptoms (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) in 28%, and severe symptoms (≥20) in 6%. When further examining the individual AUASI questions from the men, frequency and nocturia were the most common symptoms reported.…”

Section: Resultsmentioning

confidence: 99%

Lack of Disparity in Lower Urinary Tract Symptom Severity Between Community-Dwelling Non-Hispanic White, Mexican-American, and African-American Men

Markland

Thompson

Ankerst

et al. 2007

Urology

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Objectives-With significant differences in risks of renal failure in different ethnic/racial groups in the U.S., we sought to determine if disparities exist in reporting lower urinary tract symptoms (LUTS) in Non-Hispanic White (NHW), Mexican American (MA), and African American (AA) men. Epidemiological studies in AA men suggest they may have more LUTS compared to NHWs, but little is known about symptom prevalence among MA men.Methods-Data were collected from a prospective, community-based cohort assembled to study risk factors associated with prostate cancer. Measures included demographics, prostate specific antigen (PSA), body mass index (BMI), and family history of prostate cancer. LUTS severity was assessed in 2,804 (1,485 NHW, 964 MA, 355 AA) men without prostate cancer using the American Urological Association Symptom Index (AUASI).Results-No significant difference (p = 0.998) was seen in prevalence of moderate or severe LUTS in NHW (34%), MA (34%), and AA (33%) men. No differences were found in either obstructive or irritative symptoms among the three groups. Age, PSA level, BMI, and family history did not affect symptom severity.Conclusions-Rates of moderate to severe LUTS symptoms in this cohort were similar to those in other community-based populations of NHW men. Lower rates of moderate/severe symptoms were noted in AA men than previously reported. MA men had similar degrees of LUTS as the general population, and with their increased risk for diabetes and renal disease, in-depth study of this population is warranted.

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Section: Resultsmentioning

confidence: 99%

Lack of Disparity in Lower Urinary Tract Symptom Severity Between Community-Dwelling Non-Hispanic White, Mexican-American, and African-American Men

Markland

Thompson

Ankerst

et al. 2007

Urology

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“…25,26 Racial differences in renal vascular hemodynamic factors and susceptibility to hypertension and diabetes have been shown to affect urinary albumin excretion rates and may contribute in part to the significantly greater odds of macroalbuminuria for black participants in this study. [27][28][29] Low birth weight also was associated with a decrease in nephron number, suggested to increase the risk for systemic and glomerular hypertension in adult life, as well as increase the risk for expression of renal disease after exposure to potentially injurious renal stimuli, thereby contributing to the excess prevalence of CVD and CKD in racial/ethnic minority populations. 30 The relatively lower OR (1.66 versus 1.98) for macroalbuminuria in this race at FPL of 200% or greater compared with FPL less than 200% highlights the compounding effect of poverty on whatever physiological risks there might be in this vulnerable population.…”

Section: Discussionmentioning

confidence: 99%

The Association of Poverty With the Prevalence of Albuminuria: Data From the Third National Health and Nutrition Examination Survey (NHANES III)

Martins

Tareen

Zadshir

et al. 2006

American Journal of Kidney Diseases

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Background-Albuminuria is a major risk factor for the development and progression of chronic kidney disease (CKD) and cardiovascular disease. Socioeconomic factors also have been reported to modify CKD and cardiovascular risk factors and clinical outcomes. The extent to which poverty influences the prevalence of albuminuria, particularly among racial/ethnic minority populations, is not well established. The influence of poverty on the prevalence of albuminuria and the implication of this relationship for the racial and/or ethnic differences in the prevalence of albuminuria were examined.

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“…Despite practice guidelines recommending that patients in CKD stages 4-5 should be under nephrologist care (6,17), late nephrologist care is still common (18). Moreover, rates of receiving pre-ESRD nephrologist care have long been lower for blacks than whites (12,18,19).…”

Section: Introductionmentioning

confidence: 99%

“…Although the receipt of nephrologist care is influenced by individual as well as contextual factors such as those related to residence, prior studies have mostly examined individual factors (12,(19)(20)(21), or the few studies that examined contextual factors have generally examined them separately (22)(23)(24) or were limited to certain regional areas (15,25). An important knowledge gap exists regarding broad regional (e.g., state-level) differences in the utilization of nephrologist care among patients with CKD stages 4-5.…”

Section: Introductionmentioning

confidence: 99%

Interstate Variation in Receipt of Nephrologist Care in US Patients Approaching ESRD

Gao

Cheung

Greene

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Although multiple factors influence access to nephrologist care in patients with CKD stages 4-5, the geographic determinants within the United States are incompletely understood. In this study, we examined interstate differences in nephrologist care among patients approaching ESRD.Design, setting, participants, & measurements This national, population-based analysis included 373,986 adult patients from the US Renal Data System, who initiated maintenance dialysis between 2005 and 2009. Multilevel logistic regression was used to examine interstate variation in nephrologist care ($12 months before ESRD) for overall and four race-age subpopulations (black or white and older or younger than 65 years). ResultsThe average state-level probability of having received nephrologist care in all states combined was 28.8% (95% confidence interval, 25.2% to 32.7%) overall and was lowest (24.3%) in the younger black subpopulation. Even at these lower levels, state-level probabilities varied considerably across states in overall and subpopulations (all P,0.001). Overall, excluding the states in the upper and lower five percentiles, the remaining states had a probability of receiving care that varied from 18.5% to 41.9%. The lower probability of receiving nephrologist care for blacks than whites among younger patients noted in most states was attenuated in older patients. Geographically, all New England states and most Midwest states had higher than average probability, whereas most Middle Atlantic and Southern states had lower than average probability. After controlling for patient factors, three state-characteristic categories, including general healthcare access measured by percentage of uninsured persons and Medicaid program performance scores, preventive care measured by percentage of receiving recommended preventive care, and socioeconomic status, contributed 55%-66% of interstate variation.Conclusions Patients living in states with better health service and socioeconomic characteristics were more likely to receive predialysis nephrologist care. The reported national black-white difference in nephrologist care was primarily driven by younger black patients being the least likely to receive care.

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Delayed referral of black, Hispanic, and older patients with chronic renal failure

Cited by 94 publications

References 23 publications

Lack of Disparity in Lower Urinary Tract Symptom Severity Between Community-Dwelling Non-Hispanic White, Mexican-American, and African-American Men

Lack of Disparity in Lower Urinary Tract Symptom Severity Between Community-Dwelling Non-Hispanic White, Mexican-American, and African-American Men

The Association of Poverty With the Prevalence of Albuminuria: Data From the Third National Health and Nutrition Examination Survey (NHANES III)

Interstate Variation in Receipt of Nephrologist Care in US Patients Approaching ESRD

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