Guofen Yan, Ph.D., from the University of Virginia School of Medicine in Charlottesville, and colleagues conducted a retrospective cohort study using data from the U.S. Renal Data System for 1,547,438 adults with no prior transplantation and first dialysis treatment between April 1, 1995, and Sept. 28, 2012. For each racial/ethnic group, the hazard ratios of death for the territories (American Samoa, Guam, Puerto Rico, and Virgin Islands) versus the 50 states were calculated. A total of 22,828 patients were treated in the territories and 1,524,610 patients were treated in the 50 states.
The researchers found that compared with the 50 states, in the territories, the crude mortality rate was lower for whites (14 versus 29 deaths per 100 patient-years), similar for blacks (18 and 17, respectively), and higher for Hispanics (27 versus 16) and Asians (22 versus 15). The risks for death remained greater for Hispanics and Asians living in the territories versus their counterparts in the 50 states in matched analyses (hazard ratios, 1.65 and 2.01, respectively). For black and white patients, no significant differences in mortality were seen in the territories versus the 50 states.
“Further studies are needed to better understand the influence of issues such as genetic factors, insurance coverage, health infrastructure, health beliefs and behaviors, social networks, and other subtleties in the United States territories that may add critical insights to our observations,” the authors write.
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