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Survival on dialysis among American Indians and Alaska Natives with diabetes in the United States, 1995-2010

TitleSurvival on dialysis among American Indians and Alaska Natives with diabetes in the United States, 1995-2010
Publication TypeJournal Article
Year of Publication2014
AuthorsBurrows, NR, Cho, P, K. Bullard, MK, Narva, AS, Eggers, PW
JournalAm J Public HealthAm J Public Health
Volume104 Suppl 3
Date PublishedJun
ISBN Number1541-0048 (Electronic)<br/>0090-0036 (Linking)
Accession Number24754656
KeywordsAlaska/epidemiology/ethnology, Diabetic Nephropathies/ethnology/ mortality/therapy, European Continental Ancestry Group/statistics & numerical data, Female, Humans, Indians, North American/ statistics & numerical data, Inuits/ statistics & numerical data, Kidney Failure, Chronic/ethnology/mortality/therapy, Male, Middle Aged, Population Surveillance, Renal Dialysis/ mortality, Survival Analysis, United States/epidemiology
AbstractOBJECTIVES: We assessed survival in American Indians and Alaska Natives (AI/ANs) with end-stage renal disease attributed to diabetes who initiated hemodialysis between 1995 and 2009. METHODS: Follow-up extended from the first date of dialysis in the United States Renal Data System until December 31, 2010, kidney transplantation, or death. We used the Kaplan-Meier method to compute survival on dialysis by age and race/ethnicity and Cox regression analysis to compute adjusted hazard ratios (HRs). RESULTS: Our study included 510,666 persons-48% Whites, 2% AI/AN persons, and 50% others. Median follow-up was 2.2 years (interquartile range = 1.1-4.1 years). At any age, AI/AN persons survived longer on hemodialysis than Whites; this finding persisted after adjusting for baseline differences. Among AI/AN individuals, those with full Indian blood ancestry had the lowest adjusted risk of death compared with Whites (HR = 0.58; 95% confidence interval = 0.55, 0.61). The risk increased with declining proportion of AI/AN ancestry. CONCLUSIONS: Survival on dialysis was better among AI/AN than White persons with diabetes. Among AI/AN persons, the inverse relationship between risk of death and level of AI/AN ancestry suggested that cultural or hereditary factors played a role in survival.
Ethno Med: