Race,Hispanic origin,and socioeconomic status in relation to motor vehicle occupant death rates and risk factors among adults

Black and Hispanic adults travel less in motor vehicles than whites but may be at greater risk when they do travel. Passenger vehicle occupant deaths per 10 million trips among persons ages 25-64 were computed by race, Hispanic origin, gender, and socioeconomic status (SES) using 1995 data from the Fatality Analysis Reporting System (FARS) and Nationwide Personal Transportation Survey. Educational level was used as the indicator of SES. Blacks, particularly black men, were at increased risk of dying relative to whites when traveling in motor vehicles (rate ratio (RR) for black men=1.48; 95% confidence interval (CI)=1.42-1.54). Hispanic men, but not Hispanic women, also had elevated occupant death rates, but their risk was less than that of black men (RR=1.26; 95% CI=1.20-1.31). SES was the strongest determinant of occupant deaths per unit of travel; RRs among those who had not completed high school were 3.52 (95% CI=3.39-3.65) for men and 2.79 (95% CI=2.69-2.91) for women, respectively. Whites without high school degrees had the highest death rates per 10 million trips. After adjustment for SES, the elevated risk of occupant fatalities persisted among black men and women, but not among Hispanic men. Seat belt use and alcohol-impaired driving were examined among fatally injured passenger vehicle drivers. Among those with no education beyond high school, higher percentages were reported as having high blood alcohol concentrations (BACs) or having not used belts. Reported belt use rates were lower among black men and women, even after controlling for SES, whereas Hispanic men and women had belt use rates similar to those of whites. High BACs were more common among Hispanic men, which appeared largely to be an effect of SES because most Hispanic men killed in crashes had not completed high school, the education level with the highest percentage that drove while impaired by alcohol. More effective public health efforts are needed to reduce occupant deaths among persons of lower SES, blacks, and Hispanics, including measures to increase use of seat belts and reduce alcohol-impaired driving.     

Driving under the influence (DUI) among U.S. ethnic groups

OBJECTIVE: To report nationwide survey data on driving under the influence of alcohol and drugs (DUI) among U.S. ethnic groups. METHODS: Data come from a probability sample of 39,250 adults 18 years of age and older interviewed by the U.S. National Household Survey on Drug Abuse in 2000. Interviews averaging 1h in length were conducted in respondents' homes by trained interviewers. The survey response rate was 74%. RESULTS: Self-reported rates of DUI were highest among White men (22%), Native American/Native Alaskan men (20.8%) and men of Mixed race (22.5%). Twelve-month arrest rates for DUI were highest among men of Mixed race (5%) and Native American/Native Alaskan men (3.2%). Drinkers who DUI are more likely to be men (regardless of ethnicity), not married, consume more alcohol, and be alcohol dependent than drinkers who do not engage in alcohol-impaired driving. However, important ethnic specific predictors are also identified across the different ethnic groups.     

The Hispanic Americans Baseline Alcohol Survey (HABLAS): Rates and predictors of DUI across Hispanic national groups

This paper examines rates of self-reported driving under the influence (DUI) of alcohol and 12-month and lifetime DUI arrest rates among Mexican Americans, Puerto Ricans, Cuban Americans and South/Central Americans in the U.S. population. Using a multistage cluster sample design, a total of 5224 individuals 18 years of age and older were selected from the household population in five metropolitan areas of the U.S.: Miami, New York, Philadelphia, Houston and Los Angeles. The survey weighted response rate was 76%. Among men, 21% of Mexican Americans, 19.9% of South/Central Americans, 11.6% of Puerto Ricans and 6.9% of Cuban Americans reported DUI. Rates were lower among women, ranging from 9.7% for Mexican Americans to 1.3% for Cuban Americans. Mexican American men had the highest 12-month arrest rate (1.6%) and the highest lifetime arrest rate (11.2%). Drinkers who reported DUI were heavier drinkers than those not reporting DUI according to a variety of indicators. However, most DUI incidents involved non-alcohol-dependent drivers. Mexican Americans and South Central/Americans, men, younger drivers, those with less than high school education, those with higher income and higher alcohol consumption were more likely to report DUI and DUI arrests. These findings show that Hispanic national groups in the U.S. are diverse regarding drinking and DUI-related experiences.     

A population-based study on the prevalence and correlates of drinking and driving in Hong Kong

To examine the prevalence and correlates of drinking and driving in Hong Kong, an anonymous, random telephone survey was conducted on 9860 Chinese adults (18-70 years of age) from April to June 2006. Trained interviewers administered a structured interview consisting of questions on socio-demographic information, drinking pattern, drink-driving, and motor vehicle accidents. The census age-standardized past-year prevalence of driving within 2 h of drinking was 5.2% among males and 0.8% among females. The prevalence across age showed an inverted U-shaped trend for males peaking at 8.2% between 41 and 45 years. For females the prevalence was fairly stable between the ages of 20 and 55. The past-year prevalence of alcohol-related motor vehicle accidents was 0.1%, with the majority being in the 26-30 age group. For males who drank, the prevalence of drinking and driving was 5.0% among those without problem drinking, 14.8% among binge drinkers, 37.1% among alcohol abusers and 22.4% among the alcohol dependent. For females who drank, the corresponding figures were all lower at 1.2%, 6.9%, 12.1% and 12.5%, respectively. Higher socio-economic status, weekly drinking, binge drinking and alcohol abuse were independently associated with higher likelihood of drinking and driving in both genders. Among drinking drivers, having a job that required drinking was the only predictor of having had a motor vehicle accident. The elevated prevalence of drinking and driving among alcohol abusers, binge drinkers and the alcohol dependent may portend higher population-level rates of alcohol-related motor accidents in the future since the prevalence of problem drinking has previously been noted to be increasing rapidly in Hong Kong.     

Rates and predictors of DUI among U.S.–Mexico border and non-border Mexican Americans

This paper examines driving under the influence (DUI) arrests and other related factors among Mexican Americans living in U.S.–Mexico border and non-border areas. Respondents in the non-border areas (primarily Houston and Los Angeles) constitute a multistage probability sample (N = 1288) of these areas, interviewed as part of the 2006 Hispanic Americans Baseline Alcohol Survey (HABLAS). Respondents in the border area (N = 1307) were interviewed between March 2009 and July 2010 and constitute a household probability sample of Mexican Americans living on the border. In both surveys, data were collected during computer assisted interviews conducted in respondents’ homes. The HABLAS and the border sample response rates were 76% and 67%, respectively. Border or non-border residential location was not associated with self-reported DUI, 12 month DUI arrest, or lifetime DUI arrest. An increase in consumption of 5 drinks per week was associated with an 18% increase in the chance of self-reporting DUI and an 18% increase in the probability of a lifetime DUI arrest. Binge drinkers were more likely to self-report a DUI event (OR = 2.85, 95% CI = 1.61–5.03; p < .001) and a lifetime DUI arrest (OR = 2.81; 95% CI = 1.43–5.53, p < .01). Most respondents, independent of residential location, recognized DUI as a major problem affecting Hispanics. However, while most correctly identified the legal blood alcohol content to drive in their state as .08 g/dl or lower, approximately one third of individuals were unaware of the legal limit. Compared to their non-border counterparts, border men were more likely to identify a bar/tavern/club and border women were more likely to identify a friend or relative's home as the places of last drink before the most recent DUI trip originated. In conclusion, border and non-border Mexican Americans are not different regarding DUI rates. These rates are high in both groups, especially among men. Intervention strategies to decrease DUI should be implemented not only in drinking establishments but also with families.     

Seat belt use among African Americans,Hispanics, and Whites

OBJECTIVES: This study investigated seat belt use among White, Black, and Hispanic drivers, in cities in which standard enforcement of the belt use law is permitted (primary enforcement) and in cities in which a motorist has to be first cited for another offense (secondary enforcement). Socioeconomic and gender differences in belt use were also studied. METHODS: Belt use observations were obtained at gas stations in Boston, Chicago, Houston, and New York City. In short interviews with drivers, information on race/ethnicity and education was obtained. RESULTS: Belt use was higher in primary enforcement cities, among women, and among those with at least a college degree. In primary law cities there were no clear differences in belt use by race/ethnicity; in secondary cities African Americans were less likely than Whites or Hispanics to be belted, among populations both with and without college degrees. This is consistent with data from other studies indicating that African Americans are more sensitive than Whites to the enforcement of primary laws and are more likely to increase belt use when states shift from secondary to primary. There has been no evidence of enforcement bias against African Americans--increases in citations generally have been greater among Whites than African Americans once primary enforcement is implemented. CONCLUSIONS: More widespread application of primary laws--standard throughout the world but in only 17 US states and the District of Columbia--would increase belt use for all drivers, especially African Americans.     

Fatal red light crashes: the role of race and ethnicity

There is an increasing number of motor vehicle crashes (MVCs) in the U.S. that occur at intersections. Noncompliance with traffic signals is one of the causes for such increase. In this study, we focused on Hispanic drivers. It has been shown that failing to follow traffic laws and regulations is a major cause of MVCs in Latin America. Does this driving behavior in Latin America correspond to the Hispanic community in the U.S.? Are U.S. Hispanics more likely to die in a red light incident? Are Hispanics more likely to be red light runners than other racial/ethnic groups in the U.S.? We answered these questions by taking advantage of a 1990-1996 Fatality Analysis Reporting System (FARS) file with additional racial/ethnic information. Overall, we found no differences between African-American, White, and Hispanic drivers regarding red light running. We found that drinking and driving was the most important factor for red light running. However, we found evidence that some Hispanic subgroups may be more vulnerable to red light running. One such subgroup is formed by Hispanics who have no valid driver license and no record of previous driver license suspension. This study is the first to apply national, archival data to document the relevance of race/ethnicity to the red light running problem, and we hope that it might serve as an incentive for more research on this area.     

Bicycle safety helmet legislation and bicycle-related non-fatal injuries in California

The objective of this study was to determine whether the bicycle safety helmet legislation in California, enacted in 1994, was associated with statistically significant reductions in head injuries among bicyclists aged 17 years and under who were subjected to the law. The study used 44,069 patient discharge cases from all public hospitals in California, from 1991 through 2000, and a case-control design to make direct comparisons between those subjected to the law (Youth) and those who were not (Adult) across the pre- and post-legislation periods. An aggregate data analysis approach and a pooled disaggregate data fitting technique using multinomial logit models were applied. The legislation was found to be associated with a reduction of 18.2% (99% confidence interval: 11.5-24.3%) in the proportion of traumatic brain injuries (Head-TBI) among Youth bicyclists. The proportions of other head, face, and neck injuries were not significantly changed across the pre- and post-legislation periods in this age group but there was a corresponding increase of 9% (5-13%) in the proportion of all other injuries. On the other hand, there was no statistically significant change in the proportions of injury outcomes for Adult bicyclists. The youngest riders, aged 0-9 years, had the greatest decrease in the proportion of Head-TBI. The reduction was the same for motor vehicle and non-motor-vehicle-related incidents. The bicycle safety helmet legislation was associated with a decrease in the likelihood of Head-TBI for non-urban residents but not for urbanites, for males but not for females, and for Whites, Asians, and Hispanics, but not Blacks and others.     

Alcohol, illicit and non-illicit psychoactive drug use and road traffic injury in Thailand: A case-control study

The objective of this study was to determine the relationship between alcohol use, psychoactive drug use and road traffic injury (RTI). A case-control study was conducted among drivers in Bangkok, Thailand. Two hundred cases and 849 controls were enrolled between February and November 2006. Cases who sustained a RTI were matched with four controls recruited from petrol stations within a 1-km radius of the reported crash site of the case.A positive alcohol breath test (≥50 mg/dl), and positive tests for the presence of illicit (amphetamine, cocaine, marijuana) and non-illicit psychoactive drugs (antihistamine, benzodiazepine, antidepressants), using gas chromatography/mass spectrometry (GC/MS) were documented as primary measures.There were significantly higher odds of an alcohol breath test ≥50 mg/dl (adjusted odds ratio (OR) 63.6 (95% CI: 25.5-158.9)), illicit psychoactive drugs (adjusted OR 3.4 (95% CI: 1.7-6.6)) and non-illicit psychoactive drug (adjusted OR 3.1 (95% CI: 1.5-6.3)) among cases than controls.Even though driving under the influence of psychoactive drugs has been significantly linked to RTI, its contribution to road safety is much lower than driving under the influence of alcohol. With limited resources, the priority for RTI prevention should be given to control of driving under the influence of alcohol.     

Exploring the effects of attitudinal and perception characteristics on drinking and driving non-compliant behaviour

The objective of this paper is to examine a number of factors (observed and latent) that might have a causal effect on drinking and driving (D&D) behaviour. Face-to-face surveys were conducted among patrons at bars and cafeterias and 305 valid questionnaires were filled. A confirmatory factor analysis was performed so as to identify the latent constructs and a mixed structural equation model was developed. From the analysis it came up that non-compliant behaviour of D&D is limited at older ages, also associated with high levels of income and car availability. Though men are consuming more alcohol, women seem to be more prone in driving under the influence (DUI) of alcohol. Furthermore, it was found that people who strongly support the examined interventions in the study (e.g. better enforcement, more traffic safety campaigns, stricter penalties) are more unlikely to drive after drinking compare to those who have some objections. Finally, it was not found any statistically significant relation between individuals’ level of awareness and D&D behaviour.     

Medicinal and illegal drugs among Danish car drivers

The objective of this study was to get an insight into the prevalence of medicinal and illegal drugs among car drivers in a Danish rural area. The police randomly stopped about 1000 car drivers and asked them to deliver a saliva sample and gave them a questionnaire to fill in at home. Laboratory analyses by specific methods of samples, which a screening found positive, confirmed that 2% were positive for benzodiazepines or illegal drugs (amphetamine, cannabis, cocaine or opiates): 1.3% were positive for illegal drugs and 0.7% for benzodiazepines. Questionnaire statements from some of the drivers confirm that occasionally some of these drive despite a suspicion to be under the influence of an illegal drug (2.8%), an illegal drug including alcohol (4%), a hazardous medicinal drug including alcohol (8.5%), or alcohol alone above the legal limit (24.5%). These results are considered reliable for the survey area and may not reflect national conditions. The overall results indicate that in this study driving under the influence of illegal drugs or alcohol seems to be associated to especially men, aged 22–44 years. Driving under the influence of hazardous medicinal drugs seems to be associated to middle-aged/elderly drivers, both men and women.     

Young drivers' evaluation of driving impairment due to alcohol

Ninety-six college students, 18-20 years of age, were selected from three drinking categories (abstain-light, moderate, and heavy) based on their self-reported drinking habits. Subjects rated the relative importance of three driving components (attention, control/maneuvering, and emergency responses) for safe driving and the impairment each component and overall driving ability would sustain after driver drinking. Impairment ratings were made of the effects of drinking the number of drinks that would have resulted in the rater having blood alcohol concentrations (BACs) of .05%, .10%, and .15%. Subjects also estimated the number of drinks that they could consume in one hour and then safely drive after after different time periods, the time they should wait before driving after drinking various amounts of alcohol, and the number of beer, wine, wine cooler, and whiskey drinks that would cause them to reach a .10% BAC. While the driving components were rated to be of approximately equal importance for safe driving, the emergency responses component was judged to be more impaired following alcohol consumption than any of the other components, or overall driving ability. Heavy drinkers judged that there was significantly less driving impairment due to alcohol than did light or moderate drinkers in the case of overall driving ability and all of the driving components except emergency responses. Heavy drinkers also judged it safe to consume a number of drinks before driving that would result in higher mean BACs than those of light and moderate drinkers. Both drinking category and gender differences were found in the estimated BAC values that would have occurred at the time of driving after waiting periods judged by subjects to be sufficient for safe driving.     

Is driving under the influence of cannabis becoming a greater risk to driver safety than drink driving? Findings from a longitudinal study

The present study examined the associations driving under the influence of (a) cannabis and (b) alcohol, and motor vehicle collisions during, in a longitudinal study of a New Zealand birth cohort (n=936). Participants reported significantly (p<.0001) greater rates of driving under the influence of cannabis than driving under the influence of alcohol during ages 21-25. Also, there were statistically significant bivariate associations between increasing levels of both: (a) driving under the influence of cannabis and (b) self-reported driving under the influence of alcohol, and increased risks of active motor vehicle collisions (p<.0001). These associations were adjusted for potentially confounding factors including average distance driven and self-reported risky driving behaviours. After adjustment, the associations between driving under the influence of cannabis and motor vehicle collisions remained marginally significant (p=.064), whereas adjustment for confounding factors reduced the association between driving under the influence of alcohol and motor vehicle collisions to statistical non-significance (p>.70). The results of the present study suggest that, for some populations, the risks of driving under the influence of cannabis may now be greater than the risks of driving under the influence of alcohol.     

Let them experience a ride under the influence of alcohol; a successful intervention program?

A considerable amount of all traffic accidents can be attributed to driving under the influence of alcohol. In particular the group of drivers aged 18–24 years is involved in many serious traffic accidents where alcohol turns out to be a major factor. In fact this age group shows about three times as many alcohol related traffic fatalities as all other categories of road users. The intervention program “Alcohol-free on the road” (Dutch: “Alcoholvrij op weg”) aims to enhance young people's awareness of the effects of alcohol by letting them personally experience the effect of alcohol on their driving abilities. To this end, young drivers were invited to a closed circuit and allowed to drive first sober and then intoxicated, guided and guarded by driving instructors. Based on several other studies it was thought that a realistic experience of the effects of alcohol on driving abilities may contribute to a better understanding of the impact of alcohol and may stimulate attitudes that are needed to support the conscious decision not to drive while intoxicated.After more than ten years of running and data collection, 1200 young drivers have participated in the intervention program. In a quasi-experimental study with a non-equivalent group design, the program is evaluated in order to assess its effectiveness both with respect to the attitudes of the participants and the actual relevant behaviour in the years after the alcohol experience intervention program they attended, i.e. the incidence of actually driving under the influence of alcohol. To do this, a questionnaire was sent to a subset (415) of the participants who have completed the program, along with a control group (450), to compare attitudes and actual behaviour. In addition, the Public Prosecutor checked the files of those who responded, for the occurrence of driving under the influence of alcohol. The group that participated in the alcohol intervention program showed more awareness about the dangers of driving while intoxicated than the control group, and this group reported improved alcohol law compliance. Furthermore, less participants in the intervention program than in the control group were present in the Public Prosecutor files, respectively 0.7% and 4.2%. Hence, the alcohol driving experience intervention program might turn out to be effective and successful in decreasing driving under the influence of alcohol. Although the results of the present study are no more than suggestive, they may be considered a first step towards demonstrating the effectiveness of this type of intervention. However, the intervention is unique and warrants a more robust evaluation. A large-sized randomized controlled trial should be conducted in the next phase to confirm the findings that the intervention program is a suitable educational tool to decrease driving under the influence of alcohol. The present paper serves to raise awareness of this intervention and its potential.     

A three-year prospective study of rearrests for driving under influence of alcohol or drugs

Fifty drunken drivers and 50 drivers with high blood drug concentrations arrested during the first four months of 1983 were selected for a study of rearrests for driving under influence of alcohol or drugs. Of the drugged drivers selected, 32 had been driving with high blood concentrations of diazepam (greater than 1.0 microM). 50% of these drivers were rearrested during the subsequent three years. The rearrest rate was low (6%) among those who had been driving with high blood concentrations of amphetamine (greater than 2.0 microM) or THC (greater than 0.010 microM). Among the drunken drivers arrested (BAC greater than 0.05%), the rearrest rate was 20%. The drivers were mostly rearrested for driving under the influence of alcohol.     

Prevalence of impaired driving behaviors in a diverse, rural, southern middle school

Little research has been reported on the risky behaviors of pre-driving adolescents revolving around alcohol use, in particular impaired driving behaviors, which in general have been shown to be higher in rural areas. This study investigated the prevalence of drinking while driving and riding with a drinking driver among 290 middle school students in a Mississippi Delta area middle school. Just under half (45.3%) responded that at least once in the past 30 days they had ridden with a drinking driver and 17% indicated they had driven an automobile after drinking alcohol. The prevalence of underage drinking, driving under the influence of alcohol, and riding with a drinking driver among our sample of middle school students is alarming. This study shows alcohol-related driving behaviors are not solely performed by those who are legally licensed to drive, but simply by those who have access to vehicles. The authors recommend that prevention programs focusing on reducing the incidence of impaired driving should start in early adolescence.     

Disparities in publication patterns by gender, race and ethnicity based on a survey of a random sample of authors

Gender and racial disparities have greatly diminished in academia over the last 30 years, but attrition rates among women and minority faculty still remain high. In this paper we examine gender and racial disparities in publishing, an activity that is important for career advancement, but has not been incorporated adequately into the debate on faculty attrition. We surveyed a random sample of 1,065 authors who contributed a peer-reviewed journal article indexed in the Web of Science (WoS) in 2005 and at least one other article during the period of 2001–2004 in four academic disciplines representing natural sciences (biochemistry and water resources) and social sciences (anthropology and economics). We then report on the relationships between demographic variables (gender and race/ethnicity) and career-related variables (academic rank, discipline, and h-index) of these authors. Our findings show that at every career level and within each discipline, women were under-represented in academic positions compared to men and an even lower percentage of women published at each academic level than were employed at that level. Further, we found that women had lower h-indices than men in all four disciplines surveyed. Societal and biological constraints may reduce women’s ability to obtain research intensive positions and contribute to these gender disparities. Hispanics and blacks were underrepresented among individuals awarded with doctoral degrees, doctorate recipients employed in academia, and academics publishing in WoS as compared to their representation in the population. Whites, Asians, and Native Americans and Pacific Islanders were adequately or over-represented in each category. Additionally, blacks had lower h-indices than the other ethnic groups across the disciplines surveyed. Compared to women, attrition among blacks and Hispanics appears to occur earlier in their career development. Cumulative experiences with discrimination and stereotypes may partly explain higher attrition and lower publication productivity among blacks and Hispanics.     

Retail alcohol monopolies, underage drinking, and youth impaired driving deaths

OBJECTIVE: To explore associations of state retail alcohol monopolies with underage drinking and alcohol-impaired driving deaths. DATA: Surveys on youth who drank alcohol and binge-drank recently and their beverage choices; census of motor vehicle fatalities by driver blood alcohol level. METHODS: Regressions estimated associations of monopolies with under-21 drinking, binge drinking, alcohol-impaired driving deaths, and odds a driver under 21 who died was alcohol-positive. RESULTS: About 93.8% of those ages 12-20 who consumed alcohol in the past month drank some wine or spirits. In states with a retail monopoly over spirits or wine and spirits, an average of 14.5% fewer high school students reported drinking alcohol in the past 30 days and 16.7% fewer reported binge drinking in the past 30 days than high school students in non-monopoly states. Monopolies over both wine and spirits were associated with larger consumption reductions than monopolies over spirits only. Lower consumption rates in monopoly states, in turn, were associated with a 9.3% lower alcohol-impaired driving death rate under age 21 in monopoly states versus non-monopoly states. Alcohol monopolies may prevent 45 impaired driving deaths annually. CONCLUSIONS: Continuing existing retail alcohol monopolies should help control underage drinking and associated harms.     

Younger black patients have a higher risk of infection mortality that is mostly non‐dialysis related: A national study of cause‐specific mortality among U.S. maintenance dialysis patients

Introduction: While it has been well documented that in the U.S., black and Hispanic dialysis patients have overall lower risks of death than white dialysis patients, little is known whether their lower risks are observed in cause‐specific deaths. Additionally, recent research reported that younger black patients have a higher risk of death, but the source is unclear. Therefore, this study examined cause‐specific deaths among US dialysis patients by race/ethnicity and age. Methods: This national study included 1,255,640 incident dialysis patients between 1995 and 2010 in the United States Renal Data System. Five cause‐specific mortality rates, including cardiovascular (CVD), infection, malignancy, other known causes (miscellaneous), and unknown, were compared across blacks, Hispanics, and whites overall and stratified by age groups. Findings: After multiple adjustments, Hispanic patients had the lowest risk of mortality for every major cause in almost all ages. Compared with whites, blacks had a lower risk of death from CVD, malignancy and miscellaneous causes in most age groups, but not from infection. In fact, blacks had a higher risk of infection death than whites in ages 18–30 years (HR [95% CI] 1.94 [1.69–2.23]; P < 0.001), 31–40 years (HR 1.51 [1.40–1.63]; P < 0.001) and 41–50 years (HR 1.07 [1.02–1.12]; P = 0.009), which were partially attributed to their higher prevalence of AIDS nephropathy. For each race/ethnicity, more than two‐thirds of infection deaths were due to non‐dialysis related infections. Discussion: Hispanics had the lowest risk for each major cause of death. Blacks were less likely to die than whites from most causes, except infection. The previously reported higher overall mortality rate for younger blacks is attributed to their two‐fold higher infection mortality, which is mostly non‐dialysis related, suggesting a new direction to improve their overall health status. Research is greatly needed to determine social and biological factors that account for the survival gap in dialysis among different racial/ethnic groups.