@article{6f2ccf8161ca4495aa0ab2fbca75053a,
title = "Incidence of ESKD Among Native Hawaiians and Pacific Islanders Living in the 50 US States and Pacific Island Territories",
abstract = "Rationale & Objective: Native Hawaiians and Pacific Islanders (NHPI) have been reported to have the highest rates of incident end-stage kidney disease (ESKD) compared with other races in the United States. However, these estimates were likely biased upward due to the exclusion of nearly half the NHPI population that reports multiple races in the US Census. We sought to estimate the incidence rate of ESKD, including individuals reporting multiple races, and describe the clinical characteristics of incident cases by race and location. Study Design: Health care database study. Setting & Participants: US residents of the 50 states and 3 Pacific Island territories of the United States whose ESKD was recorded in the US Renal Data System (USRDS) between 2007 and 2016, as well as US residents recorded in the 2010 Census. Predictors: Age, sex, race, body mass index, primary cause of ESKD, comorbid conditions, estimated glomerular filtration rate, pre-ESKD nephrology care, and hemoglobin A1c level among ESKD cases. Outcome: Initiation of maintenance dialysis or transplantation for kidney failure. Analytical Approach: Crude ESKD incidence rates (cases/person-years) were estimated using both single- and multiple-race reporting. Results: Even after inclusion of multirace reporting, NHPI had the highest ESKD incidence rate among all races in the 50 states (921 [95% CI, 904-938] per million population per year)—2.7 times greater than whites and 1.2 times greater than blacks. Also using multirace reporting, the NHPI ESKD incident rate in the US territories was 941 (95% CI, 895-987) per million population per year. Diabetes was listed as the primary cause of ESKD most frequently for NHPI and American Indians/Alaska Natives. Sensitivity analysis adjusting for age and sex demonstrated greater differences in rates between NHPI and other races. Diabetes was the primary cause of ESKD in 60% of incident NHPI cases. Patients with ESKD living in the territories had received less pre-ESKD nephrology care than had patients living in the 50 states. Limitations: Different methods of race classification in the USRDS versus the US Census. Conclusions: NHPI living in the 50 US states and Pacific territories had the highest rates of ESKD incidence compared with other races. Further research and efforts are required to understand the reasons for and define how best to address this racial disparity.",
keywords = "American Samoa, ESRD incidence, Guam, Native Hawaiian, Northern Mariana Islands, Pacific Islander, Racial disparity, US territories, chronic kidney disease (CKD), diabetes, end-stage renal disease (ESRD), incidence rate, nephrology care, race/ethnicity, renal failure",
author = "Jie Xiang and Hal Morgenstern and Yiting Li and Diane Steffick and Jennifer Bragg-Gresham and Sela Panapasa and Raphael, {Kalani L.} and Robinson, {Bruce M.} and Herman, {William H.} and Rajiv Saran",
note = "Funding Information: Jie Xiang, PhD, Hal Morgenstern, PhD, Yiting Li, MPH, Diane Steffick, PhD, Jennifer Bragg-Gresham, PhD, Sela Panapasa, PhD, Kalani L. Raphael, MD, MS, Bruce M. Robinson, MD, MS, William H. Herman, MD, MPH, Rajiv Saran, MBBS, MD, DTCD, MRCP (UK), MS. Study conception and design: HM, RS, BMR, WHH; data acquisition: RS, JX, DS; data analysis: JX, YL; interpretation of results: all. Each author contributed important intellectual content during manuscript drafting or revision and agrees to be personally accountable for the individual's own contributions and to ensure that questions pertaining to the accuracy or integrity of any portion of the work, even one in which the author was not directly involved, are appropriately investigated and resolved, including with documentation in the literature if appropriate. This work was supported by funding from the National Institutes of Health (NIH)-NIDDK. This research was conducted under the USRDS Coordinating Center Contract (HHSN276201400001C) between the NIH-NIDDK and the University of Michigan, Ann Arbor, MI (2014-2019). The funder did not have a role in study design; data collection, analysis, or reporting; or the decision to submit for publication. The authors declare that they have no relevant financial interests. The authors gratefully acknowledge the NIDDK project officials, specifically Dr Paul Eggers and Dr Kevin Abbott, for insightful comments, encouragement, and support throughout the course of this research; USRDS Senior Project Manager Ms Vivian Kurtz at the USRDS Coordinating Center for dedication to the project; and the many programmers and analysts who worked on the national ESRD database at the Kidney Epidemiology and Cost Center at the University of Michigan, Ann Arbor, MI. Results in this manuscript were presented in part as a poster presentation at the Spring National Kidney Foundation Meeting, May 8-12, 2019, Boston, MA. Received September 19, 2019. Evaluated by 2 external peer reviewers, with direct editorial input from a Statistics/Methods Editor, an Associate Editor, and the Editor-in-Chief. Accepted in revised form January 12, 2020. Funding Information: This work was supported by funding from the National Institutes of Health ( NIH )-NIDDK. This research was conducted under the USRDS Coordinating Center Contract (HHSN276201400001C) between the NIH-NIDDK and the University of Michigan, Ann Arbor, MI (2014-2019). The funder did not have a role in study design; data collection, analysis, or reporting; or the decision to submit for publication. Publisher Copyright: {\textcopyright} 2020",
year = "2020",
month = sep,
doi = "10.1053/j.ajkd.2020.01.008",
language = "English (US)",
volume = "76",
pages = "340--349.e1",
journal = "American Journal of Kidney Diseases",
issn = "0272-6386",
publisher = "W.B. Saunders Ltd",
number = "3",
}