Effect of Race and Insurance Status on Outcomes after Vascular Access Placement for Hemodialysis
| Autor: | Irene Epelboym, Heather L. Gill, Nicholas J. Morrissey, In-Kyong Kim, Adi Wollstein, Yuriy Kotsurovskyy, Diana Catz, Jeffrey J. Siracuse |
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| Rok vydání: | 2014 |
| Předmět: |
Male
Catheterization Central Venous medicine.medical_specialty Time Factors medicine.medical_treatment Population Vascular access Comorbidity Medicare Health Services Accessibility Insurance Coverage Hospitals University Tertiary Care Centers Upper Extremity Blood Vessel Prosthesis Implantation Race (biology) Arteriovenous Shunt Surgical Renal Dialysis Internal medicine Health care medicine Humans education Aged Retrospective Studies education.field_of_study Insurance Health Medicaid business.industry Racial Groups Age Factors Urban Health Health Status Disparities General Medicine Middle Aged Kidney Transplantation United States Surgery Transplantation Treatment Outcome Insurance status Female Private Sector Hemodialysis Cardiology and Cardiovascular Medicine business |
| Zdroj: | Annals of Vascular Surgery. 28:964-969 |
| ISSN: | 0890-5096 |
| Popis: | Race and insurance status are seen as potential barriers to health care access and maintenance. Our goal was to see how these, as well as other patient and procedural characteristics, affected our populations' upper extremity vascular access outcomes.We retrospectively reviewed 601 vascular access patients from 2004 through 2012 in our urban university hospital. We recorded patient demographics, insurance status, comorbidities, and complications. Primary outcomes were reintervention, long-term mortality, and transplantation.Median age was 62 ± 15.8 years, and 58% were male. Most operations were arteriovenous fistulas (66%). The majority of patients identified themselves as Hispanic (50%), followed by white (22%), and black (19%). Most patients had Medicare only (42%), 31% had private insurance, and 27% had Medicaid as their insurance. Black/African American patients were more likely to receive an arteriovenous graft (AVG) compared with white and Hispanic patients (44% vs. 28% and 33%, P0.05). White patients were significantly older (68) than Hispanics (61) or blacks (58). Freedom from reintervention at 5 years was 55% with previous tunneled catheter use predictive. Mortality at 5 years was 35% and predicted by age, AVG placement, white race, and not receiving a kidney transplant. Predictors of not receiving a transplant included older age, lower albumin, AVG placement, and coronary artery disease.There were no disparities with insurance status in long-term outcomes in our population. Race was not a factor for reintervention or transplantation; however, black/African American patients were more likely have an AVG placed, and white patients had a lower long-term survival after access placement. |
| Databáze: | OpenAIRE |
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