Abstract
Background
Prior studies have demonstrated racial disparities in the severity of secondary hyperparathyroidism
among dialysis patients. Our primary objective was to study the racial and socioeconomic
differences in the timing and likelihood of parathyroidectomy in patients with secondary
hyperparathyroidism.
Methods
We used the United States Renal Data System to identify 634,428 adult (age ≥18) patients
who were on maintenance dialysis between 2006 and 2016 with Medicare as their primary
payor. Adjusted multivariable Cox regression was performed to quantify the differences
in parathyroidectomy by race.
Results
Of this cohort, 27.3% (173,267) were of Black race. Compared to 15.4% of White patients,
23.1% of Black patients lived in a neighborhood that was below a predefined poverty
level (P < .001). The cumulative incidence of parathyroidectomy at 10 years after dialysis
initiation was 8.8% among Black patients compared to 4.3% among White patients (P < .001). On univariable analysis, Black patients were more likely to undergo parathyroidectomy
(adjusted hazard ratio = 1.83; 95% confidence interval, 1.74–1.93). This association
persisted after adjusting for age, sex, cause of end-stage renal disease, body mass
index, comorbidities, dialysis modality, and poverty level (adjusted hazard ratio =
1.35; 95% confidence interval, 1.27–1.43). Therefore, patient characteristics and
socioeconomic status explained 26% of the association between race and likelihood
of parathyroidectomy.
Conclusion
Black patients with secondary hyperparathyroidism due to end-stage renal disease are
more likely to undergo parathyroidectomy with shorter intervals between dialysis initiation
and parathyroidectomy. This association is only partially explained by patient characteristics
and socioeconomic factors.
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Article info
Publication history
Published online: October 01, 2022
Accepted:
May 30,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
