Racial and Gender Differences in Arteriovenous Fistula Use among Incident Hemodialysis Patients
Racial and Gender Differences in Arteriovenous Fistula Use among Incident Hemodialysis Patients
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DOI：
10.1159/000318152
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发表时间：
2010-01-01
影响因子：
4.2
通讯作者：
McClellan, William
中科院分区：
文献类型：
--
作者：
Wasse, Haimanot;Hopson, Sari D.;McClellan, William
背景：动静脉瘘(AVF)的使用在不同种族和性别人群中有不同的报道。我们试图确定与AVF事件相关的危险因素，以及在控制这些因素后，AVF的使用是否存在种族和性别差异。方法：我们评估了2005年6月1日至2006年5月31日期间从5个ESRD网络开始透析的28,712例成人血液透析患者(年龄=18岁)。数据来自医疗补助和医疗保险服务中心2728表格。结果：11%的黑人和12%的白人患者报告了AVF的使用事件[OR=0.89(95%CI：0.83，0.96)]，9%的女性和13%的男性患者[OR=0.66(0.62-0.71)]。在调整了设施集群后，黑人和白人使用AVF的可能性一样高[OR=1.00(0.92-1.09)]，而性别差异仍然存在[OR=0.64(0.59-0.69)]。与透析开始前没有肾脏护理的患者相比，那些接受了12个月肾脏疾病护理的患者使用AVF的事件增加了16倍[OR=15.99(13.25-19.29)]，在接受6-12个月护理的患者中增加了9倍[OR=9.00(7.45-10.88)]，在至少接受6个月护理的患者中增加了7倍[OR=7.13(5.73-8.88)]。结论：在考虑了设施内的聚集性后，种族，而不是性别，事件AVF的使用差异被消除了。版权所有(C)2010 S.Karger AG，巴塞尔
Background: Arteriovenous fistula (AVF) use is reported to differ among racial and gender groups. We sought to identify risk factors associated with incident AVF and whether racial and gender differences in AVF use persist after controlling for these factors. Methods: We evaluated 28,712 incident adult hemodialysis patients (age >= 18) from five ESRD networks starting dialysis between June 1, 2005 and May 31, 2006. Data were obtained from the Center for Medicaid and Medicare Services 2728 form. Results: Incident AVF use was reported for 11% of black and 12% of white patients [OR = 0.89 (95% CI: 0.83, 0.96)], and for 9% of females and 13% of males [OR = 0.66 (0.62-0.71)]. After adjusting for facility clustering, blacks were as likely as whites to use an AVF [OR = 1.00 (0.92-1.09)], while gender differences persisted [OR = 0.64 (0.59-0.69)]. Compared to patients with no renal care prior to dialysis initiation, incident AVF use was 16-fold greater among those with >= 12 months of nephrology care [OR = 15.99 (13.25-19.29)], 9-fold greater among those with 6-12 months of care [OR = 9.00 (7.45-10.88)] and 7-fold greater among those with at least 6 months of care [OR = 7.13 (5.73-8.88)]. Conclusion: Racial, but not gender, differences in incident AVF use were eliminated after accounting for clustering within facilities. Copyright (C) 2010 S. Karger AG, Basel