Racial Disparities

Racial differences in access to effective medical procedures are known to be a problem in the United States. Black patients are less likely than white patients to undergo renal transplantation, coronary artery bypass surgery, and many other procedures. Despite the tendency to undertreatment in other areas, black patients are significantly overrepre-sented in the dialysis population, comprising 32 percent of all ESRD patients but only 13 percent of the United States population. There is also an overrepresentation of other racial and ethnic minority groups in the ESRD population. The increased susceptibility of nonwhite populations to ESRD has not been fully explained and probably represents a complex interaction of genetic, cultural, and environmental influences. Disparities in treatment for racial minority ESRD patients have been noted, including the following: (1) they are less likely to be referred for home dialysis and renal transplantation; (2) they are more likely to be underdialyzed; and (3) they are more likely to have less desirable synthetic grafts (shorter patency and more complications) rather than fistulas as permanent dialysis access. Nonetheless, blacks have better survival and quality of life compared to whites, and they are also less likely to withdraw from dialysis. The better outcomes despite less than optimal treatment present an opportunity to study and further improve ESRD care for minority patients.

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