Survival Differences Among Young Black and White Adults with Kidney Failure on Dialysis are Most Striking in Poor Neighborhoods

June 12, 2014—(BRONX, NY)—Researchers have found that among young adult patients with kidney failure undergoing dialysis and living in poor neighborhoods, blacks have a significantly higher risk of dying while young compared with whites. The study, involving scientists at Albert Einstein College of Medicine of Yeshiva University, Montefiore Medical Center and other institutions, was published online today in the Journal of the American Society of Nephrology (JASN). The findings suggest that social factors need to be identified that might be worsening outcomes among young black adults with kidney failure.

Tanya Johns, M.D., M.H.S.In 2009, nearly 400,000 Americans were on dialysis. This procedure—involving regular filtering of waste and excess water from blood—is the primary treatment for patients with kidney failure. The vast majority of patients on dialysis are over 65 years old. The incidence of kidney failure in the United States is 3.4 times higher in blacks versus whites.

Previous research has shown that young black dialysis patients (aged 18 to 30 years) are nearly twice as likely to die compared to similarly aged whites, but reasons for this difference are not well understood. Lead author Tanya Johns, M.D., M.H.S., assistant professor of medicine at Einstein and medical director of the Kidney Care Program and Telehealth Initiative at Montefiore, wondered whether the wealth of patients' neighborhoods could play a role. She and her colleagues merged information on 11,027 young black and white patients initiating dialysis between 2006 and 2009 from the U.S. Renal Data System with U.S. Census data regarding neighborhood wealth.

"We need to better understand how the wealth of someone’s neighborhood affects health while on dialysis so that we can effectively manage their care and improve survival."

– Tanya Johns, M.D., M.H.S.

During a median follow-up of 23 months, the researchers found that young, black adults living in poor neighborhoods had a higher risk of death from all causes compared with all other young black and white adults. When the researchers focused just on young adults living in poor neighborhoods, they found that the risk of death for blacks was about 50 percent higher than for whites. In wealthier neighborhoods, the difference in mortality between black and white young adults was much less. The findings could not be explained by medical factors such as the particular cause of patients' kidney failure or other health conditions such as diabetes or high blood pressure.

"In the United States, the incidence of end stage renal disease is 3.4 times higher in blacks compared to whites," said Dr. Johns. "Coupled with the 50 percent increased risk of death among young black adults on dialysis, this disease is a significant burden on blacks in this country. We need to better understand how the wealth of someone's neighborhood affects health while on dialysis so that we can effectively manage their care and improve survival."

The article is titled "Neighborhood Socioeconomic Status, Race and Mortality in Young Adult Dialysis Patients." Study co-authors include: Michelle Estrella M.D., M.H.S., Deidra Crews, M.D., Sc.M., Lawrence Appel, M.D., M.P.H., MS, Patti Ephraim, M.P.H., and Courtney Cook, all at Johns Hopkins University School of Medicine, Baltimore, Maryland; Cheryl Anderson, Ph.D., M.P.H., at Johns Hopkins and University of California, San Diego; and L. Ebony Boulware, M.D., M.P.H., at Johns Hopkins and Duke University School of Medicine, Durham, North Carolina.

The authors report no conflicts of interest.