The goal of this paper was to estimate incidence rates of treatment of end-stage renal disease (ESRD) in Texas for three racial/ethnic groups – Mexican Americans, blacks and non-Hispanic whites – for the period from 1978 to 1984.

Data for this study were derived from the U.S. census and the Texas Kidney Health Program, which provides financial assistance for expenses incurred prior to Medicare eligibility. Enrollment in the program is not required; therefore, the study sample might be biased by the exclusion of patients with high enough incomes/complete enough insurance coverage to pay for medical costs or patients who have trouble documenting eligibility. The authors showed that a weighted average of 12% of ESRD patients were not enrolled during the study period; they conducted sensitivity analyses to ensure bias by racial group could not substantially influence the results.

Blacks have 3.61-4.65 times the ESRD rate of non-Hispanic whites, and Mexican American have 2.40-3.21 times the rate of non-Hispanic whites. The excess rate in blacks compared with Mexican Americans is also statistically significant.

The findings suggested that non-insulin-dependent diabetes mellitus might be a major contributor to diabetes-related ESRD, particularly in blacks and Mexican Americans. Diabetes-related ESRD explains 50-60% of the excess for Mexican Americans over non-Hispanic whites in ESRD for all etiologies combined. (Note this suggests excesses must also be found in other diagnostic categories of ESRD as well.) For the younger ages, the risk of developing diabetes-related ESRD is similar for Mexican Americans and non-Hispanic whites, but by 40-49, the risk begins to rise faster for Mexican Americans. While a similar pattern is found for blacks, the rates in older age groups (50-59, 60-60, and 70+) for blacks do not rise as steeply as for Mexican Americans.

Hypertension-related ESRD, glomerulonephritic ESRD, and ESRD from unknown causes also occur more frequently in both blacks and Mexican Americans compared with non-Hispanic whites. The male-female ratio is highest for whites (1.46) and lower for blacks (1.24) and Mexican Americans (1.09). This is likely to be due to the reversal in the male-female ratio for diabetes-related ESRD for these two populations.

The authors suggest the excess may be partially explained by higher prevalence of risk factors for the development of ESRD, including level of glycemic control, duration of diabetes, coexistent hypertension, proteinuria, development of non-insulin-dependent diabetes mellitus at an earlier age, and low SES, which is associated with obesity.