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Racial/ethnic disparities related to hemodialysis access (a key survival determinant among patients with end-stage renal disease) are both a cause for alarm and a call to action, but these findings are hardly surprising. In fact, race/ethnicity and sex-based outcomes disparities are so commonly identified in surgical outcomes research that their absence from an area of clinical evidence should prompt suspicion of inadequate investigation. Although one might hypothesize that the disparities related to incident hemodialysis access in the study by Zarkowsky et al1 in this issue of JAMA Surgery may result from anatomic, physiological, or risk factors, the omnipresence of disparities across diseases and populations may instead reflect broader systems issues related to access, health literacy, and socioeconomics.
Peterson LA, Corriere MA. Focusing Quality Improvement Efforts for Hemodialysis Access. JAMA Surg. 2015;150(6):536-537. doi:10.1001/jamasurg.2015.0321