Prior studies have found lower arteriovenous fistula () creation rates in Black and Hispanic patients. Whether this is due to health care disparities or other differences is unclear. Our objective was to evaluate the racial/ethnic differences in initial surgical access type within a high-volume, safety net system with predominantly Black and Hispanic populations. A retrospective review of initial hemodialysis () access in consecutive cases between 2014 and 2019 was conducted from all five safety net hospitals in a health care system that primarily treats underserved patients. Patient data collected included race, ethnicity, sex, comorbidities, and initial arteriovenous () access type (AV fistula [] vs AV graft []). The rates of cephalic vein-based AVF (; radiocephalic, brachiocephalic) were compared with basilic and brachial vein AVF (), because the latter are performed as two stages. Bivariate and multivariate logistic regression models were adjusted for demographic and clinical variables to evaluate the relationship between race/ethnicity, surgical access type, and comorbid conditions. We included 1334 patients (74% Hispanic, 9% Black, 7% Asian, 2% White, 8% other) who underwent first-time surgical HD access creation. The majority were male (818 [63%]). Medical comorbidities were equal among groups, except for chronic obstructive pulmonary disease and stroke, which were higher in Black patients ( < .005 and = .005, respectively). Overall, 1303 patients (98%) underwent AVF creation and 31 AVG creation (2%), with no difference between race/ethnicity in AVF vs AVG creation. Of the AVF cohort, 991 (76%) had a CAVF and 312 (24%) had a BAVF. Males were more likely than females to get a CAVF (65% vs 35%; = .002). Within our safety net health system, where most patients are under-represented minorities, nearly all patients undergoing HD access had an AVF as their initial surgery with no difference in race/ethnicity. AVF type received differed by race, with Black patients twice as likely to undergo BAVF, which required two stages. Further studies are needed to identify the reasons for these differences.

中文翻译：

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种族和族裔与安全网系统中初始手术血液透析接入类型的关联

先前的研究发现黑人和西班牙裔患者的动静脉瘘形成率较低。目前尚不清楚这是由于医疗保健差异还是其他差异造成的。我们的目标是评估在以黑人和西班牙裔人口为主的大容量安全网系统中初始手术入路类型的种族/民族差异。对 2014 年至 2019 年间连续病例的初始血液透析访问情况进行了回顾性审查，该调查是在主要治疗服务不足患者的医疗保健系统中的所有五家安全网医院中进行的。收集的患者数据包括种族、民族、性别、合并症和初始动静脉 () 通路类型（AV 瘘 [] 与 AV 移植物 []）。基于头静脉的 AVF（；桡头静脉、头臂静脉）的发生率与贵要静脉和臂静脉 AVF 进行了比较，因为后者分两个阶段进行。根据人口统计和临床变量调整双变量和多变量逻辑回归模型，以评估种族/民族、手术入路类型和合并症之间的关系。我们纳入了 1334 名接受首次手术 HD 通路创建的患者（74% 西班牙裔、9% 黑人、7% 亚洲人、2% 白人、8% 其他）。大多数为男性（818 名 [63%]）。除慢性阻塞性肺病和中风在黑人患者中较高（分别 < .005 和 = .005）外，各组的医疗合并症相同。总体而言，1303 名患者 (98%) 接受了 AVF 创造，31 名患者接受了 AVG 创造 (2%)，AVF 与 AVG 创造方面的种族/民族之间没有差异。在 AVF 队列中，991 例 (76%) 患有 CAVF，312 例 (24%) 患有 BAVF。男性比女性更有可能获得 CAVF（65% vs 35%；= .002）。在我们的安全网卫生系统中，大多数患者都是代表性不足的少数族裔，几乎所有接受 HD 访问的患者都将 AVF 作为初次手术，种族/民族没有差异。接受的 AVF 类型因种族而异，黑人患者接受 BAVF 的可能性是黑人患者的两倍，这需要两个阶段。需要进一步的研究来确定这些差异的原因。