Increased Access, Persistent Disparities: Trends in Disparities in Peritoneal Dialysis (PD) Use, 2009-2019.

Peritoneal dialysis (PD) use has increased in the United States (US) since 2009, but how this has impacted disparities in PD use is unclear. We used data from the US Renal Data System (USRDS) to identify a cohort of incident dialysis patients from 2009-2019. We used logistic regression models to examine how odds of PD use changed by demographic characteristics. The incident PD population increased by 203% from 2009 to 2019, and the odds of PD use increased in every subgroup. PD use increased more among older people, as the odds for those aged ≥75 years increased 15% more per five-year period compared with individuals aged 18-44 years. (OR 1.68, 95% confidence interval [CI] 1.64-1.73 versus 1.46, 95 % CI 1.42-1.50). The odds of PD use increased 5% more per five-year period among Hispanic people compared with White people (OR 1.58, 95% CI 1.53-1.63 versus 1.51, 95% CI 1.48-1.53). There was no difference in odds of PD initiation among people who were Black, Asian or of another race. The odds of PD use increased 5% more for people living in urban areas compared with people living in non-urban areas (5-year OR 1.54, 95% CI 1.52-1.56 versus 1.46, 95% CI 1.42-1.50). The odds of PD use increased 7% more for people living in socioeconomically advantaged areas compared with people living in more deprived areas. (5-year OR 1.60, 95% CI 1.56-1.63 for neighborhoods with lowest Social Deprivation Index versus OR 1.50, 1.48-1.53 in the most deprived areas). Expansion of PD use led to a reduction in disparities for older people and for Hispanic people. Although PD use increased across all strata of socioeconomic deprivation, the gap in PD use between people living in the least deprived areas and those living in the most deprived areas widened.