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JAMA. 2002 Nov 20;288(19):2449-57.

Comparison of mortality between private for-profit and private not-for-profit hemodialysis centers: a systematic review and meta-analysis.

Author information

  • 1Depatment of Medicine, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada L8N 3Z5. philipj@mcmaster.ca

Erratum in

  • JAMA. 2004 Jan 14;291(2):186.

Abstract

CONTEXT:

Private for-profit and private not-for-profit dialysis facilities provide the majority of hemodialysis care in the United States. There has been extensive debate about whether the profit status of these facilities influences patient mortality.

OBJECTIVE:

To determine whether a difference in adjusted mortality rates exists between hemodialysis patients receiving care in private for-profit vs private not-for-profit dialysis centers.

DATA SOURCES:

We searched 11 bibliographic databases, reviewed our own files, and contacted experts in June 2001-January 2002. In June 2002, we also searched PubMed using the "related articles" feature, SciSearch, and the reference lists of all studies that fulfilled our eligibility criteria.

STUDY SELECTION:

We included published and unpublished observational studies that directly compared the mortality rates of hemodialysis patients in private for-profit and private not-for-profit dialysis centers and provided adjusted mortality rates. We masked the study results prior to determining study eligibility, and teams of 2 reviewers independently evaluated the eligibility of all studies. Eight observational studies that included more than 500 000 patient-years of data fulfilled our eligibility criteria.

DATA EXTRACTION:

Teams of 2 reviewers independently abstracted data on study characteristics, sampling method, data sources, and factors controlled for in the analyses. Reviewers resolved disagreements by consensus.

DATA SYNTHESIS:

The studies reported data from January 1, 1973, through December 31, 1997, and included a median of 1342 facilities per study. Six of the 8 studies showed a statistically significant increase in adjusted mortality in for-profit facilities, 1 showed a nonsignificant trend toward increased mortality in for-profit facilities, and 1 showed a nonsignificant trend toward decreased mortality in for-profit facilities. The pooled estimate, using a random-effects model, demonstrated that private for-profit dialysis centers were associated with an increased risk of death (relative risk, 1.08; 95% confidence interval, 1.04-1.13; P<.001). This relative risk suggests that there are annually 2500 (with a plausible range of 1200-4000) excessive premature deaths in US for-profit dialysis centers.

CONCLUSIONS:

Hemodialysis care in private not-for-profit centers is associated with a lower risk of mortality compared with care in private for-profit centers.

Comment in

PMID:
12435258
[PubMed - indexed for MEDLINE]
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