The report is published in the Aug. 10 issue of the Journal of the American Medical Association.
Why the success rates differ so dramatically is unclear. The researchers suspect "an interaction between the biology of the disease in younger blacks" and racial disparities in income and access to health care, Segev said.
"There is plenty of evidence to show that blacks have less access to health care than whites," Segev said. "If you have a disease that can tolerate that, then you will be OK. But if you have a disease that becomes out of control without health care, then you're not going to be OK."
Why older blacks do better on dialysis than whites also remains an open question, Segev added. It could be that only the stronger and healthier blacks reach dialysis, while others die beforehand, he speculated.
Access to kidney transplantation may also be a contributing factor, Segev said, referring to the study findings. "If you were 18 to 30 and white, you had a 55 percent chance of getting a transplant. If you were black, only 32 percent got transplants," he said.
Among all ages, 9.1 percent of blacks got kidney transplants, compared with 12.4 percent of white patients, and whites were more likely to receive a transplant kidney from a live donor. Segev said perhaps black family members are less willing to donate kidneys or maybe fewer black patients get referred for transplants.
Whatever the reason, more blacks should be referred for transplant, he said.
Dr. Ajay Singh, clinical chief of the renal division and director of dialysis at Brigham and Women's Hospital and an associate professor of medicine at Harvard Medical School in Boston, said the study "raises questions about whether socioeconomic factors or quality of insurance coverage might explain these findings."
Finding the answers to those questions is critical for improving clinical decisions and providing equitable care, the stud
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