(HealthDay News) — For patients undergoing dialysis in the US territories versus the 50 states, mortality rates differ by race/ethnicity, according to a study published online in the Clinical Journal of the American Society of Nephrology.

Guofen Yan, PhD, 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 vs 29 deaths per 100 patient-years), similar for blacks (18 and 17, respectively), and higher for Hispanics (27 vs 16) and Asians (22 vs 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.

Continue Reading

“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.


Yan G, Shen JI, Harford R, et al. Racial and Ethnic Variations in Mortality Rates for Patients Undergoing Maintenance Dialysis Treated in US Territories Compared with the US 50 States. Clin J Am Soc Nephrol. doi:10.2215/CJN.03920319Full Text

Briggs DL. Disparities in Health Outcomes with Dialysis in the United States Vary by Race. Clin J Am Soc Nephrol. doi:10.2215/CJN.13881119rial