Family structure and patient survival in an African-American end-stage renal disease population: a preliminary investigation

Few studies have examined the influence of the family on the course of chro nic illness in African-Americans. We explore the relationship between famil y structure, defined as marital status and household composition, and patie nt survival. Patient gender was examined as a possible moderator in this re lationship. Using data from a survey of 476 African-American end-stage rena l disease (ESRD) patients, a significant association between household comp osition and patient survival was found. Results from Cox proportional hazar ds model, controlling for patient age, indicated that patients who live in 'complex' households (i.e. those with a partner and/or others) are at great er risk for shortened survival as compared to those who live alone or with a spouse/partner (p < 0.05). When we examined whether patient gender modera tes this relationship, female patients who live in these households were fo und to be at 2 times greater risk for shortened survival (p < 0.01) than fe male patients who live alone or with their spouse/ partner only. Family str ucture was not significantly associated with survival in male patients. Dis cussion and implications of findings are addressed. (C) 1999 Elsevier Scien ce Ltd. All rights reserved.