ABSTRACT
BACKGROUND AND OBJECTIVES: In the United States mortality rates for patients treated with dialysis differ by racial and/or ethnic (racial/ethnic) group. Mortality outcomes for patients undergoing maintenance dialysis in the United States territories may differ from patients in the United States 50 states. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This retrospective cohort study of using US Renal Data System data included 1,547,438 adults with no prior transplantation and first dialysis treatment between April 1, 1995 and September 28, 2012. Cox proportional hazards regression was used to calculate hazard ratios (HRs) of death for the territories versus 50 states for each racial/ethnic group using the whole cohort and covariate-matched samples. Covariates included demographics, year of dialysis initiation, cause of kidney failure, comorbid conditions, dialysis modality, and many others. RESULTS: Of 22,828 patients treated in the territories (American Samoa, Guam, Puerto Rico, Virgin Islands), 321 were white, 666 were black, 20,299 were Hispanic, and 1542 were Asian. Of 1,524,610 patients in the 50 states, 838,736 were white, 444,066 were black, 182,994 were Hispanic, and 58,814 were Asian. The crude mortality rate (deaths per 100 patient-years) was lower for whites in the territories than the 50 states (14 and 29, respectively), similar for blacks (18 and 17, respectively), higher for Hispanics (27 and 16, respectively), and higher for Asians (22 and 15). In matched analyses, greater risks of death remained for Hispanics (HR, 1.65; 95% confidence interval, 1.60 to 1.70; P<0.001) and Asians (HR, 2.01; 95% confidence interval, 1.78 to 2.27; P<0.001) living in the territories versus their matched 50 states counterparts. There were no significant differences in mortality among white or black patients in the territories versus the 50 states. CONCLUSIONS: Mortality rates for patients undergoing dialysis in the United States territories differ substantially by race/ethnicity compared with the 50 states. After matched analyses for comparable age and risk factors, mortality risk no longer differed for whites or blacks, but remained much greater for territory-dwelling Hispanics and Asians.
Subject(s)
Asian , Health Status Disparities , Healthcare Disparities/ethnology , Hispanic or Latino , Kidney Diseases , Renal Dialysis/mortality , Adult , Black or African American , Aged , Aged, 80 and over , Female , Humans , Kidney Diseases/diagnosis , Kidney Diseases/ethnology , Kidney Diseases/mortality , Kidney Diseases/therapy , Male , Middle Aged , Pacific Islands/epidemiology , Puerto Rico/epidemiology , Race Factors , Renal Dialysis/adverse effects , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome , United States , White PeopleABSTRACT
PIP: This report estimates the population for July 1, 1980, to 1987 for the Caribbean areas of the Commonwealth of Puerto Rico, the US Virgin islands, the Pacific areas of American Samoa, Guam, and the commonwealth of the Northern Mariana Islands. The components of population change for these areas for the 1980-1987 period are also presented. Some highlights of the data follow. 1) All areas except for St. Croix and Puerto Rico are growing at a rate well above that of the US (7.4% from April 1, 1980 to July 1, 1987). 2) The Virgin Islands (population 106,100 in 1987) have shown the highest growth rate (9.8%) since 1980. Growth in St. Thomas and St. John (population 53,600) account for 72% of the total Virgin Islands growth. 3) St. Thomas and St. John together have a net immigration rate of just under 1%; St. Croix (population 52,400) had a net outmigration rate of almost 10%. 4) Puerto Rico (population 3,292,000) experienced a -7.1% net outmigration, and population increase of 95,000. 5) At 23%, Guam (population 130,400) has the largest % population growth; 21% of this growth is due to net immigration. 6) All 3 areas in the Pacific grew in the 7-year period; their overall growth rate was 23%, compared with 3% in the Caribbean areas.^ieng
Subject(s)
Data Collection , Government Publications as Topic , Population Characteristics , Population Growth , Research , Statistics as Topic , Americas , Caribbean Region , Demography , Developed Countries , Developing Countries , Guam , Latin America , Micronesia , North America , Pacific Islands , Polynesia , Population , Population Dynamics , Puerto Rico , SamoaABSTRACT
PIP: This report presents estimates of the population for July 1, 1980 to 1986 for the Commonwealth of Puerto Rico, the US Virgin Islands, American Samoa, Guam, and The Commonwealth of the Northern Mariana Islands. Census counts for 1980 are also shown for each of the areas. Components of population change for these areas for the 1980-1986 period are also shown. Most of the statistics used to prepare the area estimates were obtained from the local governments of the outlying areas. Except for Puerto Rico, all of the areas estimated are growing at a rate well above that of the US (64% from April 1, 1980 to July 1, 1986). Of the areas, Guam has exhibited the highest % of growth since 1980--19.6%. Although Puerto Rico and the Virgin Islands have increased in population since 1890, both experienced population declines between 1985 and 1986. The Virgin Islands' population declined by 1.2%, from 110,800 to 109,500, while Puerto Rico's decreased by 3%, from 3,282,000 to 3,274,000.^ieng