Received September 20, 2007
Accepted on November 9, 2007

ORIGINAL ARTICLES

Assessment of Racial Disparities in Chronic Kidney Disease Stage 3 and 4 Care in the Department of Defense Health System

Sam W. Gao ^*, David K. Oliver , Neal Das , Frank P. Hurst , Krista L. Lentine , Lawrence Y. Agodoa , Eric S. Sawyers ^||, and Kevin C. Abbott ¹

*Nephrology Service, National Naval Medical Center, Bethesda, Maryland, and the Uniformed Services University of the Health Sciences, Bethesda, Maryland, Nephrology Service, Walter Reed Army Medical Center, Washington, DC, and the Uniformed Services University of the Health Sciences, Bethesda, Maryland, St. Louis University Center for Outcomes Research (SLUCOR), St. Louis, Missouri, NIDDK, National Institute of Health, and ||National Naval Medical Center, San Diego, California

¹ To whom correspondence should be addressed. E-mail: kevin.abbott{at}us.army.mil.

	Abstract

Background and objectives: Racial disparities in provision of healthcare are widespread in the United States but have not been specifically assessed in provision of chronic kidney disease (CKD) care.

Design, setting, participants, & measurements: We conducted a retrospective cohort study of the clinical database used in a Department of Defense (DOD) medical system. Beneficiaries studied were DOD-eligible beneficiaries with CKD stage 3 (n = 7729) and 4 (n = 589) using the modified Modification of Diet in Renal Disease (MDRD)-estimated GFR formula but requiring manual correction for Black race. Compliance with selected Kidney Disease Outcomes Quality Initiative (KDOQI) CKD recommended targets (monitoring of recommended laboratory data, prescription of recommended medications, and referral to nephrology) was assessed over a 12-mo period, stratified by CKD stage. Logistic regression analysis was used to assess whether race (White, Black, or other) was independently associated with provider compliance with targets, adjusted for demographic factors and burden of comorbid conditions.

Results: Among the targets, only monitoring of LDL cholesterol was significantly less common among Blacks. For all other measures, compliance was either not significantly different or significantly higher for Black compared with White beneficiaries. However, patients categorized as "Other" race were in general less likely to achieve targets than Whites, and at stage 3 CKD significantly less likely to achieve targets for monitoring of phosphorous, hemoglobin, and vitamin D.

Conclusions: In the DOD health system, provider compliance with selected CKD stage 3 and 4 targets was not significantly lower for Black beneficiaries than for Whites, with the exception of LDL cholesterol monitoring. Patients classified as Other race were generally less likely to achieve targets than Whites, in some patients significantly so.