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Christie Barker-Cummings, MPH; William McClellan, MD, MPH; J. Michael Soucie, PhD; Jenna Krisher

JAMA. 1995;274(23):1858-1862.

Abstract
Objective.
—To evaluate the influence of ethnicity on the use of peritoneal dialysis (PD) as initial treatment for end-stage renal disease (ESRD) after controlling for other patient characteristics.

Design.
—Inception cohort analysis of incident ESRD patients.

Patients.
—All African-American and white patients (N=10 726) who began treatment for ESRD at dialysis centers in North Carolina, South Carolina, and Georgia and reported to ESRD Network 6 between January 1,1989, and December 31, 1991.

Main Outcome Measure.
—Odds ratios (ORs) of the association between ethnicity and PD as initial treatment modality.

Results.
—African-American patients were 56% less likely than whites to use PD (OR, 0.44; 95% confidence interval [CI], 0.40 to 0.49). This difference persisted (OR, 0.45; 95% CI, 0.38 to 0.52) after multivariable adjustment for age, education, social support, home ownership, functional status, albumin level, hypertension, history of myocardial infarction, peripheral neuropathy, and comorbid diabetes.

Conclusions.
—Ethnic differences in initial PD use cannot be explained by many demographic, socioeconomic, and comorbid factors associated with the use of PD as initial treatment for ESRD.

(JAMA. 1995;274:1858-1862)

Author Affiliations
From the Department of Epidemiology (Ms Barker-Cummings and Drs McClellan and Soucie), and the Center for Clinical Evaluation Sciences (Dr McClellan), Rollins School of Public Health, and the Renal Division, School of Medicine (Dr McClellan), Emory University, Atlanta, Ga; and the Southeastern Kidney Council, ESRD Network 6, Raleigh, NC (Ms Krisher). Ms Barker-Cummings is now with the Family Studies Research Unit, Sergievsky Center, Columbia University, New York, NY.

Footnotes
Reprint requests to the Center for Clinical Evaluation Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322 (Dr McClellan).

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