Association of Race and Poverty With Mortality Among Nursing Home Residents on Maintenance Dialysis.
Robert Nee, John S Thurlow, Keith C Norris and 4 others
PMID 30929962WHAT IT FOUND
Black and Hispanic nursing home residents on dialysis survived longer than non-minority peers, despite worse access to care.
Living in poorer neighborhoods increased mortality risk for everyone, but did not erase this racial survival advantage.
Key findings
01Black and Hispanic nursing home residents on dialysis had a significantly lower mortality rate than their nonblack and non-Hispanic counterparts, even after adjusting for clinical and socioeconomic factors.
02Residents in the lowest income quintile based on ZIP code had a higher risk of death compared to those in higher income areas, independent of race.
03The survival advantage for black residents remained significant after adjusting for end-of-life care preferences like hospice enrollment and dialysis withdrawal, though the effect size decreased.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study is observational and cannot prove causality. Individual income was not available; ZIP code–level median household income was used as a proxy, which may not accurately reflect individual socioeconomic status. Data on advance directives were missing and could not be included in the analysis. The duration of time spent in the nursing home before and after dialysis initiation was not recorded, which could bias results. The association between dual eligibility and lower survival is unexpected and may be influenced by residual confounding, such as younger age in that group.
Declared interests
The authors declare no conflicts of interest. The study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases.
The easy way to misread this
Do not interpret the survival advantage for black and Hispanic residents as evidence that their care is better or that they are healthier. The authors suggest this may be due to 'survival bias' (only the healthiest minority patients survive to reach end-stage renal disease) or lower rates of kidney transplantation, rather than superior nursing home quality or access.