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To the Editor: The retrospective cohort study by Dr Winkelmayer and colleagues¹ suggested an inverse relationship between increasing altitude and all-cause mortality among US dialysis patients after adjusting for age, sex, and race in the dialysis population. Race and ethnicity have been shown to be associated with differences in all-cause and disease-specific mortality.^2-3 In addition to differences in risk factors and genetic influences, mortality rates reflect in part racial and ethnic differences associated with health care access and quality.⁴

Because of the lower prevalence of most comorbid conditions as altitude increases, lower proportion of African American and Asian patients at higher altitudes, and higher proportion of Native Americans residing at higher altitudes, the authors appropriately adjusted for race in their estimates of all-cause mortality in the dialysis patients. However, although the mortality rates by altitude for the dialysis patients were adjusted for age, sex, and race, the comparative general population . . . [Full Text of this Article]

Ji Young Shin, MD
ableapril@hotmail.com

William C. Steinmann, MD, MSc
Department of Internal Medicine
University of Missouri
Columbia

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