ABSTRACT. Objective. Black-white disparities in the use of specific medical and surgical services have been reported in adult populations. Such disparities are not well documented in children. We sought to determine whether racial disparities in the use of medical services exist among children with chronic illness who have similar health insurance, specifically the choice of dialysis modality for individuals with end-stage renal disease.Design. National cross-sectional study.
Setting. Outpatient dialysis facilities throughout the United States.Patients and Participants. All Medicare-eligible children (age, 19 years) undergoing renal replacement therapy in 1990 in the United States, using data from the Medicare ESRD registry.Outcome Measures. The odds of receiving hemodialysis versus peritoneal dialysis according to race. Adjustment was made for differences in age, gender, cause, and duration of end-stage renal disease, income, education, and facility chracteristics using multiple logistic regression.Results. In 1990, 870 white and 368 black children received chronic (>1 year) renal replacement therapy in the United States. In bivariate analysis, blacks were two times (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.7, 2.8) more likely than whites to receive hemodialysis versus peritoneal dialysis. After controlling for other patient and facility characteristics in multivariate analysis, black children were still significantly more likely than white children to receive hemodialysis (OR, 2.4; 95% CI, 1.7, 3.5).Conclusions. Black race is strongly associated with the use of hemodialysis in children. Family, patient, or provider preferences could account for the difference in choice of therapy by race. Pediatrics 1997;99(4). URL: http://www.pediatrics.org/cgi/content/full/99/4/e6; chronic renal failure, children; racial disparities, peritoneal dialysis, health insurance.ABBREVIATIONS. ESRD, end-stage renal disease; HD, hemodialysis; PD, peritoneal dialysis; RRT, renal replacement therapy.In 1990, the Council on Ethical and Judicial Affairs of the American Medical Association called for the elimination of racial disparities in medical treatment decisions in the United States.1 They urged physicians to examine their own practices and for the profession to "increase the awareness of racial disparities in medical treatment decisions through broad discussion of the issue."1 While black-white disparities in treatment options have been previously documented in adults, particularly in nephrology, 2,3 cardiology, 4 cardiac surgery, 5 obstetrics, 1 and general internal medicine, 6 this issue has not been explored fully in populations cared for by general or subspecialty pediatricians.7 Black-white disparities in use of medical services can be confounded by differences in health insurance status making this issue difficult to examine. One population in which primary health insurance differences do not exist is in end-stage renal disease (ESRD) patients covered by Medicare insurance.Recently, lower rates in initiation of p...
