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Original ArticlesChronic Kidney Disease
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Factors Affecting Employment at Initiation of Dialysis

Rebecca J. Muehrer, Dori Schatell, Beth Witten, Ronald Gangnon, Bryan N. Becker and R. Michael Hofmann
CJASN March 2011, 6 (3) 489-496; DOI: https://doi.org/10.2215/CJN.02550310
Rebecca J. Muehrer
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Dori Schatell
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Beth Witten
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Ronald Gangnon
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Bryan N. Becker
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R. Michael Hofmann
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Article Figures & Data

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    Table 1.

    Affect of age, gender, race, and ESRD cause on maintaining employment

    1992 Through 19961997 Through 19981999 Through 2003P-int
    OR [95% CI]POR [95% CI]POR [95% CI]P
    Age group0.21
        15 to 191.27 [0.77 2.08]0.83 [0.49 1.40]0.79 [0.57 1.12]
        20 to 241.31 [1.06 1.61]0.97 [0.79 1.19]0.85 [0.75 0.97]
        25 to 291.18 [1.00 1.39]0.96 [0.82 1.11]0.97 [0.88 1.07]
        30 to 341.20 [1.03 1.39]1.09 [0.95 1.25]1.01 [0.92 1.09]
        35 to 391.27 [1.10 1.46]1.09 [0.96 1.24]1.02 [0.95 1.11]
        40 to 441.16 [1.02 1.32]1.05 [0.94 1.18]0.98 [0.91 1.05]
        45 to 491.09 [0.96 1.24]1.04 [0.93 1.16]1.05 [0.98 1.12]
        50 to 541.001.001.00
        55 to 590.99 [0.87 1.13]0.86 [0.77 0.96]0.87 [0.82 0.93]
        60 to 640.98 [0.84 1.14]0.88 [0.77 1.00]0.89 [0.82 0.97]
    0.0050.002<0.001
    Gender0.60
        women0.79 [0.73 0.85]0.81 [0.76 0.87]0.78 [0.74 0.81]
        men1.001.001.00
    <0.001<0.001<0.001
    Race<0.001
        white1.001.001.00
        black0.62 [0.57 0.68]0.69 [0.64 0.74]0.75 [0.72 0.78]
        Asian1.08 [0.90 1.29]0.97 [0.82 1.14]0.82 [0.74 0.90]
        Native American1.00 [0.75 1.33]0.93 [0.71 1.21]0.99 [0.84 1.17]
        other0.89 [0.59 1.36]0.95 [0.68 1.34]0.85 [0.73 0.98]
        Hispanic0.65 [0.58 0.74]0.67 [0.60 0.75]0.68 [0.65 0.71]0.76
    <0.001<0.001<0.001
    ESRD cause–
        diabetes1.001.001.00
        HTN0.99 [0.87 1.13]1.04 [0.93 1.17]1.02 [0.95 1.10]
        GN1.23 [1.07 1.41]1.25 [1.11 1.42]1.22 [1.13 1.32]
        other0.87 [0.76 1.01]0.91 [0.80 1.03]0.85 [0.78 0.92]
        cystic kidney1.65 [1.36 2.01]1.65 [1.38 1.98]1.68 [1.50 1.87]
        other urologic1.22 [0.92 1.60]1.16 [0.89 1.52]1.17 [1.00 1.38]
    <0.001<0.001<0.001
    • GN, Glomerulonephritis; HTN, hypertension; ESRD, End Stage Renal Disease; OR, odds ratio; CI, confidence interval; p-int, p interaction.

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    Table 2.

    Effect of certain conditions on maintaining employment

    Condition1992 Through 19961997 Through 19981999 Through 2003P-int
    OR [95% CI]POR [95% CI]POR [95% CI]P
    Inability to transfer0.33 [0.15 0.69]0.0030.50 [0.25 0.99]0.050.85 [0.54 1.34]0.490.08
    Alcohol0.63 [0.47 0.85]0.0020.56 [0.43 0.74]<0.0010.56 [0.47 0.67]<0.0010.77
    CVD0.69 [0.55 0.86]<0.0010.60 [0.50 0.72]<0.0010.70 [0.62 0.79]<0.0010.39
    Drugs0.69 [0.48 0.99]0.040.73 [0.53 1.02]0.060.73 [0.60 0.89]0.0010.96
    Cancer0.70 [0.56 0.88]0.0020.82 [0.67 1.00]0.050.73 [0.65 0.81]<0.0010.53
    CHF0.79 [0.71 0.88]<0.0010.79 [0.72 0.87]<0.0010.80 [0.76 0.85]<0.0010.93
    Tobacco0.85 [0.74 0.98]0.030.77 [0.96 0.88]<0.0010.85 [0.79 0.93]<0.0010.42
    Pericarditis0.86 [0.63 1.19]0.380.99 [0.43 1.36]0.950.97 [0.77 1.21]0.770.81
    Arrhythmia0.87 [0.67 1.13]0.291.22 [0.79 1.55]0.100.88 [0.76 1.02]0.090.06
    Inability to ambulate0.88 [0.59 1.31]0.520.64 [0.43 0.97]0.030.45 [0.35 0.58]<0.0010.02
    Ischemic heart disease0.90 [0.78 1.04]0.170.89 [0.79 1.01]0.070.92 [0.85 0.99]0.030.93
    COPD0.90 [0.70 1.15]0.400.86 [0.69 1.07]0.180.86 [0.75 0.98]0.030.95
    Cardiac arrest0.98 [0.57 1.69]0.960.64 [0.38 1.08]0.090.55 [0.39 0.76]<0.0010.19
    Diabetes (no insulin)0.98 [0.88 1.09]0.721.05 [0.95 1.16]0.321.02 [0.96 1.08]0.560.64
    PVD0.99 [0.84 1.16]0.870.84 [0.73 0.97]0.010.94 [0.86 1.02]0.150.28
    Anemia1.02 [0.93 1.12]0.720.98 [0.90 1.06]0.591.01 [0.99 1.02]0.340.33
    HTN1.06 [0.97 1.14]0.191.11 [1.03 1.20]0.0091.06 [1.00 1.11]0.030.55
    Diabetes (insulin)1.07 [0.95 1.20]0.241.00 [0.90 1.11]0.990.94 [0.89 1.00]0.050.13
    MI1.08 [0.88 1.33]0.470.90 [0.75 1.07]0.230.94 [0.84 1.05]0.300.38
    Predialysis EPO use1.22 [1.12 1.32]<0.0011.27 [1.18 1.37]<0.0011.29 [1.23 1.35]<0.0010.51
    • CVD, Coronary vascular disease; CHF, Congestive heart Failure; COPD, Chronic Obstructive Pulmonary Disease; PVD, Peripheral vascular Disease; HTN, Hypertension; MI, Myocardial Infarction; EPO, Erythropoeitin; OR, odds ratio; CI, confidence interval; p-int, p interaction.

    • View popup
    Table 3.

    Frequency of EPO use, dialysis type, and insurance type by employment status

    Employed (N, %)Unemployed (N, %)
    EPO use
        yes19,482 (67%)9496 (33%)
        no41,439 (57%)31,417 (43%)
    Primary type of dialysis
        CAPD7983 (68%)3725 (32%)
        CCPD3692 (73%)1389 (27%)
        hemodialysis45,469 (57%)34,631 (43%)
        IPD50 (54%)42 (46%)
        other28 (78%)8 (22%)
    Insurance type
        Medicaid
            yes2561 (32%)5473 (68%)
            no58,505 (62%)35,500 (38%)
        DVA
            yes460 (53%)416 (47%)
            no60,604 (60%)40,550 (40%)
        Medicare
            yes4373 (56%)3383 (44%)
            no56,735 (60%)37,612 (40%)
        employer group
            yes42,325 (68%)19,469 (32%)
            no18,770 (47%)21,504 (53%)
        other
            yes11,684 (65%)6266 (35%)
            no49,425 (59%)34,729 (41%)
        none
            yes4960 (35%)9412 (65%)
            no56,149 (64%)31,583 (36%)
    • EPO, Erythropoeitin; CAPD, Continuous ambulatory peritoneal dialysis; CCPD, Continuous cycling peritoneal dialysis; IPD, Intermittent peritoneal dialysis; DVA, Department of Veterans Affairs; OR, odds ratio; CI, confidence interval.

    • View popup
    Table 4.

    Affect of dialysis setting and dialysis mode on maintaining employment

    1992 Through 19961997 Through 19981999 Through 2003P-int
    OR [95% CI]POR [95% CI]pOR [95% CI]P
    Dialysis setting0.27
        dialysis facility1.001.001.00
        home0.98 [0.83 1.15]0.80 [0.67 0.96]1.01 [0.89 1.15]
        hospital inpatient1.16 [1.02 1.33]1.21 [1.06 1.38]1.13 [1.01 1.26]
    0.09<0.0010.08
    Primary type of dialysis0.24
        HD1.001.001.00
        CAPD1.27 [1.08 1.48]1.54 1.30 1.821.40 [1.23 1.59]
        CCPD1.37 [1.13 1.67]2.04 1.66 2.521.61 [1.40 1.87]
        IPD1.95 [0.82 4.60]1.02 0.43 2.461.47 [0.64 3.37]
        other2.13 [0.10 45.73]0.00 – –0.90[0.13 6.10]
    0.006<0.001<0.001
    • HD, Hemodialysis; CAPD, Continuous ambulatory peritoneal dialysis; CCPD, Continuous cycling peritoneal dialysis; IPD, Intermittent peritoneal dialysis; OR, odds ratio CI, confidence interval; p-int, p interaction.

    • View popup
    Table 5.

    Affect of insurance type on maintaining employment

    Insurance Type1992 Through 19961997 Through 19981999 Through 2003PP-int
    OR [95% CI]POR [95% CI]POR95% CI
    Medicaid0.40 [0.33 0.48]<0.0010.43 [0.36 0.51]<0.0010.390.35 0.43<0.0010.63
    DVA0.85 [0.58 1.23]0.380.93 [0.65 1.34]0.700.800.65 0.990.040.78
    Medicare0.98 [0.86 1.11]0.760.91 [0.80 1.02]0.110.810.74 0.88<0.0010.04
    Employer group1.73 [1.49 2.02]<0.0011.94 [1.67 2.25]<0.0011.511.36 1.67<0.0010.02
    Other1.27 [1.09 1.48]0.0031.49 [1.29 1.74]<0.0011.361.23 1.50<0.0010.33
    None0.43 [0.36 0.51]<0.0010.49 [0.41 0.58]<0.0010.430.38 0.48<0.0010.40
    • DVA, Department of Veterans Affairs; OR, odds ratio; CI, confidence interval; p-int, p interaction.

    • View popup
    Table 6.

    Erythropoietin use as a function of insurance type

    Insurance Type1992 Through 19961997 Through 19981999 Through 2003
    N (%)PN (%)PN (%)P
    Medicaid
        yes339 (19.73)376 (21.40)1208 (26.61)
        no4496 (25.17)<0.0015502 (25.85)<0.00117030 (31.18)<0.001
    Veterans Administration
        yes35 (19.34)47 (26.55)164 (31.84)
        no4797 (24.74)0.0935831 (25.50)0.7518074 (30.82)<0.001
    Medicare
        yes666 (29.18)474 (24.22)1132 (33.36)
        no4193 (24.17)<0.0015405 (25.63)0.1717108 (30.68)0.001
    Employer group
        yes3203 (27.71)3942 (28.55)12407 (34.23)
        no1643 (20.44)<0.0011937 (20.97)<0.0015833 (25.47)<0.001
    Other
        yes1015 (28.73)1185 (29.09)3433 (33.37)
        no3844 (23.87)<0.0014694 (24.74)<0.00114807 (30.30)<0.001
    None
        yes332 (12.40)390 (11.86)1400 (16.67)
        no4527 (26.70)<0.0015489 (27.78)<0.00116840 (33.18)<0.001
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Clinical Journal of the American Society of Nephrology: 6 (3)
Clinical Journal of the American Society of Nephrology
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1 Mar 2011
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Factors Affecting Employment at Initiation of Dialysis
Rebecca J. Muehrer, Dori Schatell, Beth Witten, Ronald Gangnon, Bryan N. Becker, R. Michael Hofmann
CJASN Mar 2011, 6 (3) 489-496; DOI: 10.2215/CJN.02550310

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Factors Affecting Employment at Initiation of Dialysis
Rebecca J. Muehrer, Dori Schatell, Beth Witten, Ronald Gangnon, Bryan N. Becker, R. Michael Hofmann
CJASN Mar 2011, 6 (3) 489-496; DOI: 10.2215/CJN.02550310
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