Usage and Health Outcomes of Home Hemodialysis vs Center Hemodialysis in Racial/Ethnic Minority Groups in the United States a Quantitative Research in 2016–2019 USRDS Using Aday-Anderson Framework and Multiple Regression Models

Abstract

Introduction Home hemodialysis (HHD) offers patients with end-stage kidney disease (ESKD) greater flexibility and advantages of health outcomes over center hemodialysis (CHD). This study aims to investigate the differences between home and center hemodialysis with a focus on racial/ethnic minorities. Methods The US Renal Disease System (USRDS) 2019 patient core data containing mortality and hospitalization which are cumulative since 2010 were merged with 2016–2019 Medicare clinical claims. To assess demographic and medical factors adjusted utilization and mortality of HHD vs CHD within every racial/ethnic cohort, logistic regression was used, and negative binomial regression was conducted to analyze the number of hospitalizations. Results Evaluating 548,453 (97.48%) CHD patients and 14,202 (2.52%) HHD patients with Whites 47%, Blacks 32%, Hispanics 15%, Asians 4%, and other minorities 2%, the outcomes from adjusted regressions showed that: 1) minorities were significantly less likely to use HHD than Whites (Blacks: OR, 0.568, 95% CI, 0.546–0.592; Hispanics: OR, 0.510, 95% CI, 0.477–0.544; Asians: OR, 0.689, 95% CI, 0.619–0.766; Others: OR, 0.453, 95% CI, 0.390–0.525; p < 0.001); 2) most minority patients were younger and had fewer comorbidities than Whites, and all minority groups displayed significantly lower mortality and hospitalization incidences than the White group with adjustment on multiple covariates; 3) in the overall and main racial/ethnic cohorts, HHD showed a significantly lower risk of death than CHD after confounding for major risk factors (overall cohort: OR, 0.686, 95% CI, 0.641–0.734; White: OR, 0.670, 95% CI, 0.612–0.734; Blacks: OR, 0.717, 95% CI, 0.644–0.799; Hispanics: OR, 0.715, 95% CI, 0.575–0.889; Others: OR, 0.473, 95% CI, 0.265–0.844). Conclusion There are substantial racial/ethnic variations in home hemodialysis use and health outcomes in the United States.