Diagnosis of hypertensive end-stage renal disease : effect of patient's race.
The authors conducted a simulation study to examine whether the race of a patient with end-stage renal disease (ESRD) influences the diagnosis of underlying kidney disease made by the nephrologist.
The hypothesis was that ESRD may be more readily ascribed to hypertension in blacks than in whites.
Nephrologists practicing in Maryland during 1991 were sent written case histories based on the presentation of seven patients with ESRD.
For each case history, the patient's race was randomly assigned to be « black » or « white. » The nephrologist's diagnosis of underlying renal disease was recorded as « hypertensive » or « other. » Analysis of 197 case histories from 58 physicians (81% of those eligible) was performed using logistic regression.
The distribution of underlying causes of ESRD in the case histories was similar to national statistics :
hypertensive ESRD, 34% ;
diabetic ESRD, 30% ;
glomerulonephritis, 11% ;
other, 16% ;
unknown, 10%. Case histories that identified the patient's race as black were more likely (odds ratio=1.97 ; 95% confidence interval 1.05-3.68) to result in a diagnosis of hypertensive ESRD than case histories in which the patient's race was said to be white, after adjustment for case history.
Analyses that accounted for the physicians'individual tendencies to diagnose hypertensive ESRD yielded similar results.
Mots-clés Pascal : Hypertension artérielle, Complication, Stade avancé, Insuffisance rénale, Diagnostic, Homme, Race, Epidémiologie, Maryland, Etats Unis, Amérique du Nord, Amérique, Appareil circulatoire pathologie, Appareil urinaire pathologie, Rein pathologie, Néphropathie
Mots-clés Pascal anglais : Hypertension, Complication, Advanced stage, Renal failure, Diagnosis, Human, Race, Epidemiology, Maryland, United States, North America, America, Cardiovascular disease, Urinary system disease, Renal disease, Nephropathy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 95-0230428
Code Inist : 002B12B05B. Création : 09/06/1995.