Evidence map›Paper›PMID 30929962›Full record

ArticleJournal of the American Medical Directors Association2019

Association of Race and Poverty With Mortality Among Nursing Home Residents on Maintenance Dialysis.

Robert Nee, John S Thurlow, Keith C Norris, Christina Yuan, Maura A Watson, Lawrence Y Agodoa, Kevin C Abbott

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American Medical Directors Association, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact, top 95% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 7 citations in OpenAlex.

  1. Review
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 4 institutions in 1 country.

Robert NeeNephrology Service, Walter Reed National Military Medical Center, Bethesda, MD; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD. Electronic address: robert.nee.civ@mail.mil.
John S ThurlowNephrology Service, Walter Reed National Military Medical Center, Bethesda, MD; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.
Keith C NorrisDepartment of Medicine, David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA.
Christina YuanNephrology Service, Walter Reed National Military Medical Center, Bethesda, MD; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.
Maura A WatsonNephrology Service, Walter Reed National Military Medical Center, Bethesda, MD; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD.
Lawrence Y AgodoaNational Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
Kevin C AbbottNational Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
Walter Reed National Military Medical Center · USNational Institutes of Health · USUniformed Services University of the Health Sciences · USUniversity of California, Los Angeles · US

Funding

UCLA Clinical and Translational Science InstituteUL1TR000124 · NCATS · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI DUBINETT, STEVEN M. · 2012 to 2015
$57.0M
The Center for Health Improvement of Minority ElderlyP30AG021684 · NIA · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI Homero Erwin del Pino · 2002 to 2026
$19.7M
NCATS NIH HHS UL1 TR000124NIA NIH HHS P30 AG021684
6 · The paper itself

Abstract

objectivesThe association of race, ethnicity, and socioeconomic factors with survival rates of nursing home (NH) residents with treated end-stage renal disease (ESRD) is unclear. We examined whether race/ethnicity, ZIP code-level, and individual-level indicators of poverty relate to mortality of NH residents on dialysis.

designRetrospective cohort study. PARTICIPANTS/

settingUsing the United States Renal Data System database, we identified 56,194 nursing home residents initiated on maintenance dialysis from January 1, 2007 through December 31, 2013, followed until May 31, 2014. MEASUREMENTS: We evaluated baseline characteristics of the NH cohort on dialysis, including race and ethnicity. We assessed the Medicare-Medicaid dual eligibility status as an indicator of individual-level poverty and ZIP code-level median household income (MHI) data. We conducted Cox regression analyses with all-cause mortality as the outcome variable, adjusted for clinical and sociodemographic factors including end-of-life preferences.

resultsAdjusted Cox analysis showed a significantly lower risk of death among black vs nonblack NH residents [adjusted hazard ratio (AHR) 0.91, 95% confidence interval (CI) 0.89, 0.94]. Dual-eligibility status was significantly associated with lower risk of death compared to those with Medicare alone (AHR 0.80, 95% CI 0.78, 0.82). Compared to those in higher MHI quintile levels, NH ESRD patients in the lowest quintile were significantly associated with higher risk of death (AHR 1.09, 95% CI 1.06, 1.13). CONCLUSIONS/IMPLICATIONS: Black and Hispanic NH residents on dialysis had an apparent survival advantage. This "survival paradox" occurs despite well-documented racial/ethnic disparities in ESRD and NH care and warrants further exploration that could generate new insights into means of improving survival of all NH residents on dialysis. Area-level indicator of poverty was independently associated with mortality, whereas dual-eligibility status for Medicare and Medicaid was associated with lower risk of death, which could be partly explained by improved access to care.

Indexed as

Healthcare DisparitiesNursing HomesPovertyRacial GroupsRenal DialysisAgedAged, 80 and overDatabases, FactualFemaleHumansKidney Failure, ChronicMaleMiddle AgedRetrospective StudiesUnited Statesdialysisend-stage renal diseasemortalityNursing homepovertyracial disparitiesUSRDS

Identifiers

PMID30929962
PMCPMC8384553
OpenAlexW2928619660

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.