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Ethnicity, socioeconomic status, and attainment of clinical practice guideline standards in dialysis patients in the United Kingdom

Udayaraj, Udaya P., Ben-Sholmo, Yoav, Roderick, Paul, Steenkamp, Retha, Ansell, David and Tomson, Charles R.V. (2009) Ethnicity, socioeconomic status, and attainment of clinical practice guideline standards in dialysis patients in the United Kingdom Clinical Journal of the American Society of Nephrology: CJASN, 4, (5), pp. 979-987. (doi:10.2215/CJN.06311208).

Record type: Article


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

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Published date: May 2009


Local EPrints ID: 72933
ISSN: 1555-9041
PURE UUID: 553abb17-004f-4107-a524-31eee54ef6a8
ORCID for Paul Roderick: ORCID iD

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Date deposited: 25 Feb 2010
Last modified: 18 Jul 2017 23:52

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Author: Udaya P. Udayaraj
Author: Yoav Ben-Sholmo
Author: Paul Roderick ORCID iD
Author: Retha Steenkamp
Author: David Ansell
Author: Charles R.V. Tomson

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