Differences in Mortality Among Mexican-American, Puerto Rican, and Cuban-American Dialysis Patients in the United States

Frankenfield, Diane L.; Krishnan, Sangeetha M.; Ashby, Valarie B.; Shearon, Tempie H.; Rocco, Michael V.; Saran, Rajiv

doi:10.1053/j.ajkd.2008.10.049

« Previous Next »American Journal of Kidney Diseases
Volume 53, Issue 4 , Pages 647-657, April 2009

Differences in Mortality Among Mexican-American, Puerto Rican, and Cuban-American Dialysis Patients in the United States

Diane L. Frankenfield, DrPH
- Centers for Medicare & Medicaid Services, Office of Research, Development and Information, Baltimore, MD
Sangeetha M. Krishnan, MS
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
- Department of Internal Medicine, Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI
- Address correspondence to Sangeetha M. Krishnan, MS, Research Analyst, University of Michigan, Kidney Epidemiology and Cost Center, 315 W Huron, Ste 240, Ann Arbor, MI 48103-4262
Valarie B. Ashby, MS
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
- Department of Internal Medicine, Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI
Tempie H. Shearon, MS
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
- Department of Internal Medicine, Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI
Michael V. Rocco, MD, MS
- Section of Nephrology, Wake Forest University, Winston-Salem, NC
Rajiv Saran, MD, MRCP, MS
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
- Department of Internal Medicine, Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI

Received 10 April 2008; accepted 31 October 2008. published online 16 January 2009.

Background

The Hispanic ethnic group is heterogeneous, with distinct genetic, cultural, and socioeconomic characteristics, but most prior studies of patients with end-stage renal disease focus on the overall Hispanic ethnic group without further granularity. We examined survival differences among Mexican-American, Puerto Rican, and Cuban-American dialysis patients in the United States.

Study Design

Prospective observational study.

Setting & Participants

Data from individuals randomly selected for the End-Stage Renal Disease Clinical Performance Measures Project (2001 to 2005) were examined. Mexican-American (n = 2,742), Puerto Rican (n = 838), Cuban-American (n = 145), and Hispanic-other dialysis patients (n = 942) were compared with each other and with non-Hispanic (n = 33,076) dialysis patients in the United States.

Predictors

Patient characteristics of interest included ethnicity/race, comorbidities, and specific available laboratory values.

Outcomes

The major outcome of interest was mortality.

Results

In the fully adjusted multivariable model, 2-year mortality risk was significantly lower for the Mexican-American and Hispanic-other groups compared with non-Hispanics (adjusted hazard ratio, 0.79; 95% confidence interval, 0.73 to 0.85; adjusted hazard ratio, 0.81; 95% confidence interval, 0.71 to 0.92, respectively). Differences in 2-year mortality rates within the Hispanic ethnic groups were statistically significant (P = 0.004) and ranged from 21% lower mortality in Mexican Americans to 3% higher mortality in Puerto Ricans compared with non-Hispanics.

Limitations

Include those inherent to an observational study, potential ethnic group misclassification, and small sample sizes for some Hispanic subgroups.

Conclusion

Mexican-American and Hispanic-other dialysis patients have a survival advantage compared with non-Hispanics. Furthermore, Mexican Americans, Cuban Americans, and Hispanic others had a survival advantage compared with their Puerto Rican counterparts. Future research should continue to examine subgroups within Hispanic ethnicity to understand underlying reasons for observed differences that may be masked by examining the Hispanic ethnic group as only a single entity.

Index Words: Hispanic, Mexican American, Puerto Rican, Cuban American, ethnicity, disparity, outcomes, mortality