Mortality Risk between For-Profit and Not-For-Profit Dialysis Facilities
A recent meta-analysis suggested that the relative risk of mortality is 8% higher in private for-profit hemodialysis (HD) centers than private not-for-profit HD centers (Devereaux et al. JAMA 2002; 288: 2449). Objective:
To assess the association between dialysis center profit status and mortality using USRDS data in the current era under DOQI guidelines. Methods:
We studied incident HD patients from 1995 to 2000 who had Medicare as primary payer during the 4th through 6th month after ESRD initiation. Patients who died or underwent transplant during the 6 months after initiation were excluded. Primary dialysis provider was determined from the majority provider during the 6 months after initiation. Patient mortality for the following 12 months was evaluated via Cox regression, which adjusted for age, gender, primary cause of ESRD, race, cumulative hospital days, and comorbidity measures, which were assessed through both Medicare claims during the entry period and the Medicare Evidence form 2728. Patients were followed up until transplantation, death, or completion of the 12 months. Results:
189,932 patients receiving HD during 1995–2000 were included in our analysis. The adjusted mortality rate was 271.6 per 1000 person-years at the private for-profit centers and 272.2 at the private not-for-profit centers. The mortality risk relative to private for-profit vs. not-for-profit centers was 1.009 (95% CI, 0.978–1.042; p = 0.558). Sub-analyses that excluded hospital-based facilities showed similar results. Although public not- for-profit facilities were excluded from the analysis, a sub-analysis performed with these also showed similar results. Conclusion:
Our results suggest that dialysis center profit status was not associated with mortality. This lack of association was found in the combined 1995–2000 population and in separate models for each year. Freestanding vs. hospital-based and public vs. non-public facility had no impact on the results.
Document Type: Research Article
Publication date: 2004-01-01