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      Health Differences between Roma and Non-Roma in the Slovak Dialyzed Population

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          Abstract

          Background: Roma health has not been studied systematically. Thus far, it has been shown that Roma compared to non-Roma have a significantly higher likelihood of getting end-stage renal disease and that their chances for survival on dialysis are lower. Evidence is lacking regarding morbidity between Roma and non-Roma. The aim was to compare the health status of dialyzed Roma and non-Roma using the Charlson comorbidity index (CCI). All Slovak dialysis centers for adults were asked to fill in a questionaire with demographic and clinical data, including comorbidity. Cross-sectional analysis of 2082 patients with an average age of 63.8 ± 13.8 years was performed. Comorbidity was expressed as the CCI, and ethnic differences were calculated. Linear regression was performed to adjust for differences in gender and age in both ethnic groups. Roma represented 13.0% of the whole dialyzed population (n = 270). Comorbidity expressed as CCI was significantly lower in the Roma population ( p < 0.001). After adjusting for gender and age, ethnicity failed to be associated with the CCI in the linear regression analysis ( p = 0.965, variance of the model—adjusted R 2 38.6%). The health status of dialyzed Slovak Roma does not differ cross-sectionally when adjusted for age and gender from the health status of dialyzed non-Roma.

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          Most cited references15

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          Adapting the Charlson Comorbidity Index for use in patients with ESRD.

          Accurate prediction of survival for patients with end-stage renal disease (ESRD) and multiple comorbid conditions is difficult. In nondialysis patients, the Charlson Comorbidity Index has been used to adjust for comorbidity. The purpose of this study is to assess the validity of the Charlson index in incident dialysis patients and modify the index for use specifically in this patient population. Subjects included all incident hemodialysis and peritoneal dialysis patients starting dialysis therapy between July 1, 1999, and November 30, 2000. These 237 patients formed a cohort from which new integer weights for Charlson comorbidities were derived using Cox proportional hazards modeling. Performance of the original Charlson index and the new ESRD comorbidity index were compared using Kaplan-Meier survival curves, change in likelihood ratio, and the c statistic. After multivariate analysis and conversion of hazard ratios to index weights, only 6 of the original 18 Charlson variables were assigned the same weight and 6 variables were assigned a weight higher than in the original Charlson index. Using Kaplan-Meier survival curves, we found that both the original Charlson index and the new ESRD comorbidity index were associated with and able to describe a wide range of survival. However, the new study-specific index had better validated performance, indicated by a greater change in the likelihood ratio test and higher c statistic. This study indicates that the original Charlson index is a valid tool to assess comorbidity and predict survival in patients with ESRD. However, our modified ESRD comorbidity index had slightly better performance characteristics in this population.
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            Charlson comorbidity score is a strong predictor of mortality in hemodialysis patients.

            The Charlson comorbidity index (CCI) is a commonly used scale for assessing morbidity, but its role in assessing mortality in hemodialysis patients is not clear. Age, a component of CCI, is a strong risk factor for morbidity and mortality in chronic diseases and correlates with comorbidities. We hypothesized that the Charlson comorbidity index without age is a strong predictor of mortality in hemodialysis patients. A 6-year cohort of 893 hemodialysis patients was examined for an association between a modified CCI (without age and kidney disease) (mCCI) and mortality. Patients were 53±15 years old (mean±SD), had a median mCCI score of 2, and included 47% women, 31% African Americans and 55% diabetics. After adjusting for case-mix and nutritional and inflammatory markers including C-reactive protein and interleukin-6, 2nd (mCCI: 1-2), 3rd (mCCI=3), and 4th (mCCI: 4-9) quartiles compared to 1st (mCCI=0) quartiles showed death hazard ratios (95% confidence intervals) of 1.43 (0.92-2.23), 1.70 (1.06-2.72), and 2.33 (1.43-3.78), respectively. The mCCI-death association was robust in non-African Americans. The CCI-death association linearity was verified in cubic splines. Each 1 unit higher mCCI score was associated with a death hazard ratio of 1.16 (1.07-1.27). CCI independent of age is a robust and linear predictor of mortality in hemodialysis patients, in particular in non-African Americans.
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              Are barriers in accessing health services in the Roma population associated with worse health status among Roma?

              The health of Roma has been found to be poorer than that of the majority population. The aim of this study was to explore the differences between Roma and non-Roma regarding perceived barriers in accessing health services. Furthermore, we aimed to assess the association between self-rated health status and Roma ethnicity and explore to what degree barriers in accessing health services explain this association.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                18 February 2018
                February 2018
                : 15
                : 2
                : 360
                Affiliations
                [1 ]Pediatric Department, Faculty of Medicine, Safarik University, 040 11 Kosice Slovak Republic
                [2 ]Graduate School Kosice Institute for Society and Health, Faculty of Medicine, Safarik University, 040 11 Kosice, Slovak Republic; mamajern@ 123456gmail.com (M.M.); rosenberger.jaroslav@ 123456gmail.com (J.R.); j.p.van.dijk@ 123456umcg.nl (J.P.v.D.)
                [3 ]Nephrology and Dialysis Centre Fresenius Nitra, 949 01 Nitra Slovak Republic; zuzana.straussova@ 123456gmail.com
                [4 ]Nephrology and Dialysis Centre Fresenius Kosice, 040 11Kosice, Slovak Republic
                [5 ]Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands
                Author notes
                [* ]Correspondence: gabriel.kolvek@ 123456upjs.sk ; Tel.: +42-1552-354-132
                Author information
                https://orcid.org/0000-0001-7201-889X
                Article
                ijerph-15-00360
                10.3390/ijerph15020360
                5858429
                29463019
                6c3e690a-928e-4801-8ae5-fec723278e4e
                © 2018 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 18 December 2017
                : 14 February 2018
                Categories
                Article

                Public health
                roma,health,dialysis,slovakia
                Public health
                roma, health, dialysis, slovakia

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