# Differential survival selections and care-related determinants among African Americans and Hispanics versus whites with chronic kidney disease

> **NIH NIH R01** · UNIVERSITY OF VIRGINIA · 2020 · $351,112

## Abstract

Project Summary
This proposal represents our continuing efforts to contribute to NIDDK's Strategic Plan to eliminate racial and
ethnic disparities in chronic kidney disease (CKD), including end-stage renal disease (ESRD; stage 5 CKD).
Despite extensive research over the last two decades, critical knowledge gaps persist. First, African Americans
(AAs) and Hispanics continue to have 2-3 times higher incidence of ESRD than non-Hispanic whites (whites),
but paradoxically have much better survival than whites after reaching ESRD and undergoing dialysis.
Speculation is that this apparent survival advantage is related to survival disadvantage and inadequate care for
AAs and Hispanics during the pre-ESRD period, but confirming this has been hampered by methodological
challenges. Second, we still do not understand how differences in mortality between minorities and whites
evolve over time as the disease advances. And third, we do not fully grasp how processes of care, which are
potentially modifiable and vital to improving outcomes, affect survival selections among minorities (vs. whites).
 To close these longstanding knowledge gaps, we propose to conduct the first event-history analysis of
national incident CKD populations to examine in-depth racial/ethnic disparities in outcomes and processes of
care over the full course of CKD. Our central hypothesis is that differences in mortality between minorities (AAs
and Hispanics) and whites are time-dependent over the course of CKD, and that differences in ESRD are
related to the differences in pre-ESRD, which result from differential survival-selection processes between the
groups. The analyses proposed under our three Specific Aims will test this and other specific hypotheses and
examine a range of factors for the differential survival selections, particularly the processes of care. Aim 1 will
yield a detailed characterization of how racial/ethnic differences in mortality evolve over the full course of CKD.
Aim 2 will examine the effect of processes of care on differential survival selections among racial/ethnic
groups, which drives the time-dependent changes found in Aim 1. Aim 3 will assess the role of unexplained
risks in these differential survival-selection processes. In addition to our novel hypotheses and innovative
analytic approaches, this study will foster methodological advances in CKD research, which include the use of
1) two national incident CKD cohorts with >15 years of follow-up that connect the pre-ESRD and ESRD
periods—the national veteran CKD population (>1.3 million) for primary analyses, and the Medicare CKD
population (>790,000) for further understanding of processes of care across the nation; and 2) advanced
statistical techniques, including time-dependent multi-state survival models and frailty models. This study will
offer novel understanding of why differential survival rates among AAs and Hispanics vs. whites exist and how
they can be addressed. Our results for real-world processes ...

## Key facts

- **NIH application ID:** 9830058
- **Project number:** 5R01DK112008-03
- **Recipient organization:** UNIVERSITY OF VIRGINIA
- **Principal Investigator:** Guofen Yan
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $351,112
- **Award type:** 5
- **Project period:** 2017-12-05 → 2021-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9830058

## Citation

> US National Institutes of Health, RePORTER application 9830058, Differential survival selections and care-related determinants among African Americans and Hispanics versus whites with chronic kidney disease (5R01DK112008-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9830058. Licensed CC0.

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