The Survival of Roma Minority Patients on Chronic Hemodialysis Therapy - A Romanian Multicenter Survey

Abstract

ObjectiveThe Roma minority represents the largest ethnic group in Central and South-East European countries. Data regarding the mortality in Roma hemodialysis subjects are limited. We evaluated the 3 year mortality of ESRD Roma patients treated with hemodialysis (HD).Study Design and SettingOur prospective cohort study included 600 ESRD patients on HD therapy recruited from 7 HD centers, from the main geographical regions of Romania. The median age of the patients was 56 (19) years, 332 (55.3%) being males, 51 (8.5%) having Roma ethnicity.ResultsRoma ESRD patients initiate dialysis at a younger age, 47.8 years vs. 52.3 years (P = 0.017), present higher serum albumin (P = 0.013) and higher serum phosphate levels (P = 0.021). In the Roma group, the overall 3 year mortality was higher when compared to Caucasians (33.3% vs. 24.8%). The multivariate survival analysis revealed that being of Roma ethnicity is an independent risk factor for mortality (HR = 1.74; 95% CI = 1.04–2.91; P = 0.035).ConclusionsRoma patients with ESRD initiate HD therapy at a younger age as compared to Caucasians. They have a higher 3 year mortality rate and are dying at a younger age. Roma ethnicity represents an independent risk factor for mortality in our cohort.

Health Differences between Roma and Non-Roma in the Slovak Dialyzed Population

“…Roma ethnicity was shown to be an independent risk factor for mortality [ 8 ]. Similar to our results, the study of Gadalean et al also showed a significantly younger age of dialyzed Roma and a shorter dialysis history.…”

“…A higher prevalence of some chronic diseases, such as diseases of the cardiovascular system, diabetes mellitus, obesity as well as kidney disease, has been reported in the Roma minority [ 2 , 3 , 4 , 5 , 6 , 7 ]. So far, Roma compared to non-Roma have been shown to have a 2.4-times higher likelihood of getting end-stage renal disease (ESRD) [ 3 ] and that their chances for survival on dialysis are lower [ 8 ]. Sudzinova found a similar result in a survival study on cardiovascular disease [ 5 ].…”

Eastern European Roma: ethnic discrimination in the public healthcare system

“…Roma therefore often neglect their medical needs, thereby leading to a higher incidence of morbidity and mortality from infections and chronic illnesses. 6 One multinational study has found that pregnant Romani women were unaware of their rights to care, and therefore had a higher rate of peripartum complications compared to non-Roma counterparts. 7 Similarly, the rates of teenage pregnancy, sexually-transmitted infections, and elective termination of pregnancy are much higher in Roma populations as a result of limited sexual education.…”

Is the Definition of Roma an Important Matter? The Parallel Application of Self and External Classification of Ethnicity in a Population-Based Health Interview Survey

“…Health care staff members [ 48 ], officers [ 34 ], survey interviewers (with or without the support of a Roma community leader [ 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ]), and parents of children [ 59 , 60 ] can perform this classification. Furthermore, the combination of self-reporting and a decisive external classification is also in practice [ 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 ]. The latter approach clearly shows that external classification is considered more reliable than self-reporting in certain cases.…”