Usage and Health Outcomes of Home Hemodialysis vs Center Hemodialysis in Racial/Ethnic Minority Groups in the United States a Quantitative Research in 2016–2019 USRDS Using Aday-Anderson Framework and Multiple Regression Models

Figures & data

Table 1 Domains of Andersen Behavior Model and Their Corresponding Variables in USRDS

Domain	Categories	Variable Name and values in USRDS
Predisposing	Age	AGE AGEgroup 0=Less than 60 years old 1=Equal or older than 60 years old but less than 70 years old 2=Equal or older than 70 years old but less than 80 years old 3=Equal or older than 80 years old
	Race	ETHNIC: 0=White 1=Black 2=Hispanic 3=Asian 4=Other
	Gender	SEX: 1=Male 2=Female
Enabling	Residential Region	Region: 1=Northeast
		2=Midwest
		3=West
		4=Southwest
		5=Southeast
	Residential County and smaller area	COUNTY ZIPCODE
	Treatment modality	TREAT: 1=HHD 0=CHD
Need	Primary disease causing ESKD and other general health outcome and status	PDIS Kt/V SYEAR: Dialysis duration (service years)
	Various comorbidities	COMO_CHF COMO_ASHD COMO_CANC COMO_COPD COMO_CVATIA COMO_HTN COMO_DRUG: 0=No, without above comorbidities 1=Yes, with above comorbidities

Table 2 Patient Demographics and Clinical Characteristics by CHD/HHD

	Overall cohort	CHD	HHD	P
	N= 562,655	N=548,453	N=14,202
Age (y), mean±SD Age group (y), n (%)	69±14	70±14	64±15	<0.001
0–59	131,452 (23)	126,191 (23)	5261 (37)	<0.001
60–69	131,092 (23)	127,859 (23)	3230 (23)	<0.001
70–79	155,195 (28)	151,900 (28)	3289 (23)	<0.001
≥80	144,916 (26)	142,503 (26)	2412 (17)	<0.001
Male sex, n (%)	318,449 (57)	310,001 (57)	8448 (60)	<0.001
Dialysis duration (y), median(iqr) Race/Ethnicity, n (%)	7 (5, 11)	7 (5, 11)	8 (5, 12)	>0.05
Non-Hispanic White	262,051 (46.57)	253,765 (46.27)	8286 (58.36)	<0.001
Non-Hispanic Black	181,916 (32.33)	177,713 (32.40)	4203 (29.60)	<0.001
Hispanic	82,166 (14.60)	81,021 (14.77)	1145 (8.07)	<0.001
Asian	21,928 (3.90)	21,552 (3.93)	376 (2.65)	<0.001
Others	14,594 (2.59)	14,407 (2.63)	187 (1.32)	<0.001
Comorbidities, n (%)
Congestive heart failure	155,632 (27.60)	152,518 (27.75)	3114 (21.93)	<0.001
Atherosclerotic heart disease	74,475 (13.21)	73,175 (13.31)	1300 (9.15)	<0.001
Hypertension	505,579 (89.66)	493,067 (89.70)	12,512 (88.10)	<0.001
Cerebrovascular disease	46,908 (8.32)	45,925 (8.35)	983 (6.92)	<0.001
Cancer	33,624 (5.96)	32,666 (5.94)	958 (6.75)	<0.001
Chronic obstructive pulmonary disease	44,580 (7.91)	43,491 (7.91)	1089 (7.67)	0.288
Drug dependence	6655 (1.18)	6566 (1.19)	89 (0.63)	<0.001
Kt/V, mean±SD Region, n (%)	1.60±0.00	1.60±0.00	1.50±0.01	0.541
Northeast	90,730 (16.26)	89,144 (16.39)	1586 (11.18)	<0.001
Midwest	110,637 (19.83)	105,673 (19.43)	4964 (34.99)	<0.001
West	91,524 (16.40)	90,205 (16.59)	1319 (9.30)	<0.001
Southwest	77,657 (13.92)	76,330 (14.04)	1327 (9.35)	<0.001
Southeast	187,376 (33.58)	182,387 (33.54)	4989 (35.17)	<0.001

Table 3 Patient Demographics and Clinical Characteristics by Racial/Ethnic Groups

	Overall cohort	White	Black	Hispanic	Asian	Others	P
	n= 562,655	n=262,051	n=181,916	n=82,166	n=21,928	n=14,594
Age (y), mean±SD Age group (y), n (%)	69.39±0.02	72.48±0.03	66.08±0.03	66.07±0.05	72.41±0.10	65.88±0.12	<0.001
0–59	131,452 (23)	43,866 (17)	55,983 (31)	23,121 (28)	3975 (18)	4507 (31)	<0.001
60–69	131,092 (23)	53,016 (20)	47,132 (26)	22,794 (28)	4272 (19)	3877 (27)	<0.001
70–79	155,195 (28)	77,618 (30)	46,293 (25)	21,503 (26)	6005 (27)	3776 (26)	<0.001
≥=80	144,916 (26)	87,551 (33)	32,508 (18)	14,748 (18)	7676 (35)	2434 (17)	<0.001
Male sex, n (%)	318,448 (57)	153,164 (58)	96,856 (53)	48,438 (59)	12,374 (56)	7616 (52)	<0.001
Dialysis duration (y), median(iqr) Comorbidities, n (%)	7 (5, 11)	7 (5, 9)	9 (6, 12)	8(5, 11)	8(5, 11)	8(5, 11)	<0.001
Congestive heart failure	155,154 (28)	79,399 (30)	48,323 (27)	18,956 (23)	4917 (22)	3559 (24)	<0.001
Atherosclerotic heart disease	74,273 (13)	44,145 (17)	16,182 (9)	9457 (12)	2689 (12)	1800 (12)	<0.001
Hypertension	504,548 (90)	229,314 (88)	167,840 (92)	74,282 (90)	19,873 (91)	13,239 (91)	<0.001
Cerebrovascular disease	46,787 (8)	22,404 (9)	16,414 (9)	5432 (7)	1628 (7)	909 (6)	<0.001
Cancer	33,481 (6)	22,316 (9)	7658 (4)	2313 (3)	758 (3)	436 (3)	<0.001
Chronic obstructive pulmonary disease	44,400 (8)	29,916 (11)	10,408 (6)	2787 (3)	693 (3)	596 (4)	<0.001
Drug dependence	6646 (1)	2174 (1)	3681 (2)	615 (1)	46 (0.2)	130 (1)	<0.001
Kt/V, mean±SD	1.60±0.00	1.60±0.00	1.57±0.00	1.64±0.00	1.73±0.00	1.64±0.00	>0.05
HHD use, n (%)	14,197 (2.52)	8286 (3.16)	4203 (2.31)	1145 (1.39)	376 (1.71)	187 (1.28)	<0.001

Table 4 Odds Ratios and 95% Confidence Intervals of Home Hemodialysis Utilization (vs Center Hemodialysis) in Minority Groups (vs Whites) (from Equation 1(1) )

	Unadjusted model	P	Adjusted model	P
Race/Ethnicity, n (%)
Non-Hispanic White	Reference		Reference
Non-Hispanic Black	0.724 (0.698–0.752)	<0.001	0.568 (0.546–0.592)	<0.001
Hispanic	0.433 (0.407–0.461)	<0.001	0.510 (0.477–0.544)	<0.001
Asian	0.534 (0.481–0.593)	<0.001	0.689 (0.619–0.766)	<0.001
Others	0.398 (0.344–0.460)	<0.001	0.453 (0.390–0.525)	<0.001
Age (per 1 year increase)			0.976 (0.975–0.977)	<0.001
Sex
Male			Reference
Female			0.919 (0.888–0.951)	<0.001
Dialysis duration (per 1 year increase)			1.025 (1.022–1.028)	<0.001
Comorbidities (no)			Reference
Congestive heart failure			0.859 (0.823–0.896)	<0.001
Atherosclerotic heart disease			0.789 (0.743–0.838)	<0.001
Hypertension			0.936 (0.889–0.987)	0.014
Cerebrovascular disease			0.942 (0.881–1.007)	0.078
Cancer			1.267 (1.184–1.356)	0.154
Chronic obstructive pulmonary disease			1.048 (0.983–1.119)	<0.001
Drug dependence			0.422 (0.342–0.522)	<0.001
Region
Northeast			Reference
Midwest			2.445 (2.308–2.590)	<0.001
West			0.843 (0.782–0.909)	<0.001
Southwest			1.014 (0.940–1.093)	0.721
Southeast			1.513 (1.428–1.603)	<0.001

Figure 1 Unadjusted and adjusted odds ratios and 95% confidence intervals for home hemodialysis utilization (vs center hemodialysis) in minority groups (vs Whites). The adjusted model included demographics such as age, gender, region, dialysis service years, and medical factors such as various comorbidities and chronic conditions.

Table 5 Odds Ratios and 95% Confidence Intervals of Risk Factors for Mortality in the Overall Cohort (from Equation 2(2) )

	Odds Ratio (95% Confidence Interval)	P
Age group (y)
0–59	Reference
60–69	1.830 (1.798–1.862)	<0.001
70–79	3.139 (3.087–3.193)	<0.001
≥80	6.378 (6.264–6.495)	<0.001
Sex
Male	Reference
Female	1.013 (1.001–1.024)	0.033
Dialysis duration (per 1 year increase)	1.068 (1.067–1.070)	<0.001
HHD (vs CHD)	0.686 (0.641–0.734)	<0.001
Age group (y) interaction with treatment modality
HHD*0-59	Reference
HHD*60-69	1.517 (1.374–1.675)	<0.001
HHD*70-79	2.031 (1.838–2.244)	<0.001
HHD* ≥80	2.843 (2.504–3.228)	<0.001
Race/Ethnicity
Non-Hispanic White	Reference
Non-Hispanic Black	0.677 (0.668–0.686)	<0.001
Hispanic	0.694 (0.681–0.707)	<0.001
Asian	0.583 (0.565–0.601)	<0.001
Others	0.770 (0.741–0.799)	<0.001
Comorbidities (no)	Reference
Congestive heart failure	1.521 (1.500–1.541)	<0.001
Atherosclerotic heart disease	1.247 (1.225–1.270)	<0.001
Hypertension	0.844 (0.829–0.860)	<0.001
Cerebrovascular disease	1.327 (1.300–1.355)	<0.001
Cancer	1.138 (1.110–1.166)	<0.001
Chronic obstructive pulmonary disease	1.573 (1.539–1.609)	<0.001
Drug dependence	1.661 (1.578–1.749)	<0.001

Figure 2 Adjusted odds ratios and 95% confidence intervals for mortality in minority groups (vs Whites). The adjusted model included demographics such as age group, race, gender, region, year of hemodialysis service, treatment (HHD or CHD), medical factors such as various comorbid and chronic conditions, and treatment and age group interaction.

Table 6 Mortality of HHD vs CHD in Overall and Every Racial/Ethnic Cohort

	CHD	HHD	Odds Ratio (95% Confidence Interval)	P
Overall cohort	49.61% (272,088/548,453)	47.71% (6776/14,202)	0.686 (0.641–0.734)	<0.001
Non-Hispanic White	57.28% (145,365/253,765)	51.19% (4242/8286)	0.670 (0.612–0.734)	<0.001
Non-Hispanic Black	43.63% (77,534/177,713)	43.04% (1809/4203)	0.717 (0.644–0.799)	<0.001
Hispanic	42.26% (34,236/81,021)	42.97% (492/1145)	0.715 (0.575–0.889)	0.003
Asian	43.34% (9341/21,552)	44.41% (167/376)	0.624 (0.383–1.019)	0.059
Others	43.40% (6253/14,407)	35.29% (66/187)	0.473 (0.265–0.844)	0.011

Table 7 Odds Ratios and 95% Confidence Intervals of Risk Factors for Hospitalization in the Overall Cohort (from Equation 3(3) )

	Odds Ratio (95% Confidence Interval)	P
Age group (y)
0–59	Reference
60–69	1.140 (1.114–1.166)	<0.001
70–79	2.142 (2.089–2.197)	<0.001
≥=80	2.804 (2.727–2.883)	<0.001
Sex
Male	Reference
Female	1.155 (1.134–1.176)	<0.001
Dialysis duration (per 1 year increase)	1.210 (1.206–1.213)	<0.001
HHD (vs CHD)	0.943 (0.868–1.024)	0.162
Age group (y) interaction with treatment modality
HHD*0-59	Reference
HHD*60-69	1.126 (0.980–1.295)	0.094
HHD*70-79	1.311 (1.112–1.546)	0.001
HHD* ≥80	1.024 (0.853–1.229)	0.801
Race/Ethnicity
Non-Hispanic White	Reference
Non-Hispanic Black	0.750 (0.734–0.766)	<0.001
Hispanic	0.730 (0.710–0.750)	<0.001
Asian	0.486 (0.467–0.506)	<0.001
Others	0.706 (0.671–0.744)	<0.001
Comorbidities (no)	Reference
Congestive heart failure	1.426 (1.395–1.458)	<0.001
Atherosclerotic heart disease	1.228 (1.191–1.267)	<0.001
Hypertension	0.861 (0.836–0.887)	<0.001
Cerebrovascular disease	1.267 (1.224–1.312)	<0.001
Cancer	1.149 (1.102–1.198)	<0.001
Chronic obstructive pulmonary disease	1.562 (1.500–1.626)	<0.001
Drug dependence	1.367 (1.261–1.481)	<0.001

Figure 3 Adjusted odds ratios and 95% confidence intervals of whether have been hospitalized in minority groups (vs Whites). The adjusted model included demographics such as age group, race, gender, region, year of hemodialysis service, treatment (HHD or CHD), medical factors such as various comorbid and chronic conditions, and treatment and age group interaction.

Table 8 Hospitalization of HHD vs CHD in Overall and Every Racial/Ethnic Cohort

	CHD	HHD	Odds Ratio (95% CI)	P	Incident Rate Ratio (95% CI)	P
			Any Hospitalization		Number of Hospitalizations
Overall	88.97% (487,959/548,453)	89.52% (12,713/14,202)	0.943 (0.868–1.024)	0.162	0.985 (0.965–1.005)	0.131
White	90.85% (230,554/253,765)	89.90% (7449/8286)	0.893 (0.794–1.004)	0.059	0.979 (0.953–1.006)	0.124
Black	88.97% (158,118/177,713)	89.41% (3758/4203)	0.953 (0.835–1.087)	0.474	0.952 (0.922–0.983)	0.003
Hispanic	85.80% (69,520/81,021)	89.00% (1019/1145)	1.116 (0.868–1.433)	0.392	1.130 (1.058–1.208)	<0.001
Asian	81.45% (17,555/21,552)	85.64% (322/376)	1.338 (0.867–2.067)	0.189	1.186 (1.023–1.376)	0.024
Others	84.36% (12,154/14,407)	85.56% (160/187)	1.549 (0.844–2.845)	0.158	1.188 (1.007–1.401)	0.041