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Ethnicity, Socioeconomic Status, and Attainment of Clinical Practice Guideline Standards in Dialysis Patients in the United Kingdom

Udaya P. Udayaraj^*, Yoav Ben-Shlomo, Paul Roderick, Retha Steenkamp^*, David Ansell^*, Charles R.V. Tomson^*,, and Fergus J. Caskey

^* UK Renal Registry, Southmead Hospital, Bristol, United Kingdom; Department of Social Medicine, University of Bristol, Bristol, United Kingdom; School of Medicine, University of Southampton, Southampton, United Kingdom; Richard Bright Renal Unit, Southmead Hospital, Bristol, United Kingdom

Correspondence: Dr. Udaya P. Udayaraj, UK Renal Registry, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, UK. Phone: 0044-1179595665; Fax: 0044-1179595664; E-mail: uday{at}renalreg.com

Background and objectives: The role of socioeconomic status (SES) and its contribution to ethnic differences in standards attainment among dialysis patients is not known.

Design, setting, participants, & measurements: We examined associations between area- level SES (Townsend index) and ethnicity (white, black, South Asian) and standards attainment in 14,117 incident dialysis patients (1997–2004) in the UK.

Results: Deprived patients were less likely to achieve hemoglobin (Hb) 10g/dl (trend P < 0.001) but not after controlling for patient and center characteristics (trend P = 0.1). There was no association with hemodialysis dose and parathyroid hormone (PTH) standard but deprived patients had better attainment of phosphate (PO4) <5.6 mg/dl, calcium (Ca) and Calcium-phosphate (CaPO4) standard (e.g., most deprived versus least deprived adjusted odds ratio [OR] 1.25, 95% confidence intervals [CI] 1.12, 1.38). There was no association with SES using a lower limit for PO4 (3.5 – 5.5 mg/dl). Compared with Whites, Blacks had lower attainment of Hb (adjusted OR 0.57, 95% CI 0.45, 0.71) and PTH standards (adjusted OR 0.27, 95% CI 0.22, 0.33) but better attainment of PO4 and CaPO4, while South Asians experienced better or comparable outcomes for most standards except Ca and PTH.

Conclusions: There was no evidence of socioeconomic inequity in standards attainment or a consistent pattern of inequity by ethnic group. The lower attainment of some standards in ethnic minorities may reflect biologic differences rather than ethnicity-related inequity of care.