RACIAL-DIFFERENCES IN CHOICE OF DIALYSIS MODALITY FOR CHILDREN WITH END-STAGE RENAL-DISEASE

Objective. Black-white disparities in the use of specific medical and surgical services have been reported in adult populations. Such dispar ities are not well documented in children. We sought to determine whet her racial disparities in the use of medical services exist among chil dren with chronic illness who have similar health insurance, specifica lly the choice of dialysis modality for individuals with end-stage ren al disease. Design. National cross-sectional study. Setting. Outpatien t dialysis facilities throughout the United States. Patients and Parti cipants. All Medicare-eligible children (age, 19 years) undergoing ren al replacement therapy in 1990 in the United States, using data from t he Medicare ESRD registry. Outcome Measures. The odds of receiving hem odialysis 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 m ultiple 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 rati o [OR], 2.2; 95% confidence interval [CI], 1.7, 2.8) more likely than whites to receive hemodialysis versus peritoneal dialysis. After contr olling for other patient and facility characteristics in multivariate analysis, black children were still significantly more likely than whi te children to receive hemodialysis (OR, 2.4; 95% CI, 1.7, 3.5). Concl usions. Black race is strongly associated with the use of hemodialysis in children. Family, patient, or provider preferences could account f or the difference in choice of therapy by race.