Racial and Sex Disparities in Catheter Use and Dialysis Access in the United States Medicare Population

Abstract

BackgroundDespite efforts to increase arteriovenous fistula and graft use, 80% of patients in the United States start hemodialysis on a central venous catheter (CVC).MethodsTo better understand in incident hemodialysis patients how sex and race/ethnicity are associated with time on a central venous catheter and transition to an arteriovenous fistula and graft, our observational cohort study analyzed US Renal Data System data for patients with incident ESKD aged ≥66 years who started hemodialysis on a CVC in July 2010 through 2013.ResultsAt 1 year, 32.7% of 74,194 patients transitioned to an arteriovenous fistula, 10.8% transitioned to an arteriovenous graft, 32.1% stayed on a CVC, and 24.5% died. Women spent a significantly longer time on a CVC than men. Compared with white patients, patients who were black, Hispanic, or of another racial/ethnicity minority spent significantly more days on a CVC. In competing risk regression, women were significantly less likely than men to transition to a fistula and more likely to transition to a graft. Compared with white patients, blacks were significantly less likely to transition to a fistula but more likely to transition to a graft, Hispanics were significantly more likely to transition to a fistula, and other races/ethnicities were significantly more likely to transition to either a fistula or a graft.ConclusionsFemale patients spend a longer time on a CVC and are less likely to transition to permanent access. Compared with white patients, minorities also spend longer time on a CVC, but are more likely to eventually transition to permanent access. Strategies to speed transition to permanent access should target groups that currently lag in this area.

Healthcare disparities in vascular surgery: A critical review

“…Persons categorized as Black and persons categorized as Latino, Latina, or Latinx will have hemodialysis initiated via autogenous fistula less often than will persons categorized as White, despite being younger and with fewer comorbidities. 31 In other analyses, persons categorized as Black had comparable rates of initiation via arteriovenous fistulas, 32 higher riskadjusted rates, 33 and greater rates of maturing arteriovenous grafts at the initiation of hemodialysis. 32 Persons categorized as Black, Latino, Latina, or Latinx, and womendwho constitute approximately one half of the end-stage renal disease populationdwill spend more time with a central venous catheter than will others.…”

“…31 In other analyses, persons categorized as Black had comparable rates of initiation via arteriovenous fistulas, 32 higher riskadjusted rates, 33 and greater rates of maturing arteriovenous grafts at the initiation of hemodialysis. 32 Persons categorized as Black, Latino, Latina, or Latinx, and womendwho constitute approximately one half of the end-stage renal disease populationdwill spend more time with a central venous catheter than will others. 32 Symptomatic carotid disease.…”

“…32 Persons categorized as Black, Latino, Latina, or Latinx, and womendwho constitute approximately one half of the end-stage renal disease populationdwill spend more time with a central venous catheter than will others. 32 Symptomatic carotid disease. Little is known about equity in access to endarterectomy or stenting for carotid artery disease.…”

Sex-related disparities in intervention rates and type of intervention in patients with aortic and peripheral arterial diseases in the National Inpatient Sample Database

“…A study on catheter use and dialysis access in the United States revealed that females and minorities spent more time on a central venous catheter, when compared with their male counterparts, despite efforts to transition patients to permanent access more quickly. 18 Another study demonstrated significant disparities in the presentation, management, and outcomes between males and females with acute myocardial infarctions. 19 One article even assessed the biological and environmental factors contributing to racial, ethnic, and sex disparities in vascular surgery.…”

Global health inequality and women – beyond maternal health

“…This intersectionality between socio‐economic status, sex and gender extends to numerous other examples that demonstrate inequity in healthcare. Female patients undergoing dialysis spend a longer time with a central venous catheter and are less likely to transition to permanent access than men [20]. Women with an acute abdomen present later than men and are often referred to a gynaecologist, missing life‐threatening non‐obstetric causes; this gender‐linked delay in presentation and diagnosis has also been seen in patients with stroke, cancer and in women presenting with chest pain.…”