Progress Toward Elimination of Health Disparities

The following discussion highlights progress toward the elimination of health disparities. The disparities are illustrated in the Disparities Table (see Figure 4-2), which displays information about disparities among select populations for which data were available for assessment.

Populations with the best rates were identified for each objective. Among select populations, the white non-Hispanic population had the lowest rate of new cases of ESRD (4-1) and kidney failure due to diabetes (4-7). The white non-Hispanic population also had the highest proportion receiving a kidney transplant within 3 years of the date of renal failure (4-6). The white non-Hispanic population with CKD due to diabetes had the greatest proportion receiving the recommended treatment to reduce progression (4-8b). The Asian or Pacific Islander population had the highest rate for registration on the kidney transplant wait list (4-5). Similarly, in persons with diabetes and chronic kidney disease, the proportion of patients who receive medical evaluation (4-8a), such as eye exams, lipids, and hemoglobin A1c, was highest in the Asian population. For persons with ESRD, the Asian or Pacific Islander population also had the lowest (best) rate for cardiovascular deaths (4-2) and the best rate for the use of arteriovenous fistulas for hemodialysis (4-4). The American Indian or Alaska Native population with CKD and ESRD had the best rate of counseling for chronic kidney failure care (4-3).

Compared with men, women had a lower rate of new cases of ESRD (4-1) and a lower rate of diabetic ESRD (4-7). No gender difference was noted in counseling for chronic kidney disease care (4-3) or in medical evaluation of persons with CKD and type 1 or 2 diabetes (4-8a). Compared with women, men had a higher rate for the use of arteriovenous fistulas for hemodialysis (4-4), were more likely to be registered on the kidney transplant wait list (4-5), and had a shorter wait time after renal failure before kidney transplantation (4-6). Men with ESRD had a lower cardiovascular death rate (4-2) than women with ESRD had.

Disparities continued to exist in the evaluation and treatment of persons affected by CKD. The black population had the highest rate for ESRD overall (4-1), nearly four times that of the white population (the best group). The ESRD rate (4-1) for the American Indian or Alaska Native population was more than twice the best rate. Despite these high levels of disparity, both groups showed improvement. The disparity in the rate for the American Indian or Alaska Native population and the white population decreased by about 80 percentage points between 1997 and 2002. The comparable decrease for the black population in comparison to the best rate was 39 percentage points. For diabetic kidney disease (4-7), the American Indian or Alaska Native population had the highest rate until 2000. The diabetic ESRD rate of this population declined since 1998; in 2001, it fell below the rate experienced by the black population.

Between 1992–94 and in 1999, the wait time to receive a kidney transplant (4-6) showed increasing disparity for the American Indian or Alaska Native population in comparison with the best group. The proportion of Asian or Pacific Islander CKD and ESRD patients who received counseling for appropriate care (4-3) was 50 percent to 99 percent lower than that of the best (American Indian or Alaska Native population) group. For cardiovascular death rates of all ESRD cases (4-2), the rate for the white non-Hispanic population was 32 percent higher than the best rate.

While the burden of new cases of ESRD (4-1) continued to increase, the total increase in the rate between 1999 and 2002 was less than 4 percent. The American Indian or Alaska Native population showed a 28 percent decrease in new cases of ESRD (4-1), from 716 cases in 2000 to 514 in 2002. Much of the decrease may be attributable to the increase in the population since the 2000 census in which all multirace designations with the American Indian or Alaska Native group now contribute to the denominator.¹ More years of data are needed to determine if the post-2000 census trend continues. The rate for new cases of ESRD among the Asian or Pacific Islander population also slightly decreased. The rates appeared to be stable between 2000 and 2002 in the Hispanic, white non-Hispanic, and black non-Hispanic populations.

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