Chapter Two Incidence & prevalence

Chapter Two Incidence & prevalence Science is the observation of things possible, whether present or past. Prescience is the knowledge of things which may come to pass, though but slowly. LEONARDO da Vinci Vol esrd Ch pg 31

Contents 34 Incidence 36 Prevalence 38 Network populations 4 Summary Growth of the end-stage renal disease (ESRD) program is typically characterized by assessment of total patient counts at a single point in time (point prevalence), of new cases accepted for treatment (incidence), and of patients receiving kidney transplants. Disease rates are computed based on the number of patients per million people in the general population, and are adjusted for age, gender, and race. This year we update our projections using data available through December 31, 7, and compare results for incidence, prevalence, and mortality both to projections presented in our JASN paper, which used data through, and to those in the 8 ADR, using data through 6. Current projections are down slightly compared to those shown last year, and to results presented in the paper for 1. The primary reason for these differences is a continued flattening of incident rates in most age and race groups. The 6 growth in the incident population reversed in 7, with rates returning to the flattened level seen since 1. Although the incidence of ESRD due to diabetes has increased among younger minority patients, rates have been stable or falling in older populations and among whites (see Figure 1.1 in Chapter One), showing that a detailed assessment of subpopulations is required to determine whether trends are consistent across all groups defined by age, gender, race, ethnicity, and cause of ESRD. A new finding this year is that the number of elderly patients and those age 4 64 appears to have peaked, though this will require additional years of data to confirm. By race, data on incidence generally show the same flattening as the overall ESRD rates, though rates have been falling among Native Americans. This trend is not universal, however, as incidence among Native Americans younger than 4 has been on the rise. By primary cause, the adjusted rate of new ESRD cases due to diabetes fell 3.3 percent in 7, to 1 per million population. The rate of ESRD due to glomerulonephritis continues to fall, returning to levels seen in the early 199s. It is not clear if this finding is related to improved blood pressure control and greater use of ACE-Is or ARBs, or if hypertension and diabetes are now so common that there is some misclassification of primary diagnosis. Additional investigations will be needed to assess the care of these patients, and to determine if detection and treatment continue to improve. Data on the median age of incident patients show important trends; the slight decline in the age of white and Asian patients may illustrate an increasing number of patients age 4 64 entering ESRD, a reflection of the expanding number of post-war baby boomers reaching their middle years. In 7, the adjusted incident rate for patients age 4 64 fell to the same level seen in 611 per million population. The rate for those age 7 and older rose 1.4 percent during the same period, to 1,73, and that for patients age 44 grew. percent, to 16. Racial and ethnic discrepancies in ESRD persist, with 7 incident rates in the African American and Native American populations 3.7 and 1.8 times greater, respectively, than the rate among whites, and the rate in the Hispanic population 1. times higher than that of non-hispanics. Even after adjustments for age and gender, rates of ESRD continue Ch pg 3

to vary widely across the U.S. This year we update our data on ESRD in the major metropolitan statistical areas (MSAs) of the United States. Among African Americans, for instance, the incidence of ESRD is greatest in the Denver, Colorado area, while for Hispanics it is highest in the MSA centered around Cincinnati, Ohio. These variations may reflect different burdens of chronic kidney disease, as well as regional differences in the use of detection efforts and treatment interventions in populations at risk for kidney failure. The prevalent population age 7 and older has nearly doubled since 1997, now reaching more than 81,, while the number of patients age 4 64 has grown 8 percent. The population age 44, in contrast, is just 16. percent larger now than a decade ago. Prevalent rates per million population are growing most quickly among patients age 6 and older, with an overall increase of 4 8 percent since, and of 4 and 7 percent for ages 6 74 and 7 and older, respectively, in the past decade. Regional variations in ESRD prevalence reflect differences in adjusted survival, in part related to higher rates of transplantation in certain areas of the U.S. Still to be determined is whether these data reflect short- or long-term trends, as the emergence of the baby boomers into a senior population will continue to contribute to the growth 1ii Projected counts of incident & prevalent ESRD patients through Incident 16 1 8 4 JASN paper: 136,166 (1) 8 ADR: 1,77 () New projection: 14,88 () Actual: 11,996 (7) Prevalent 8 JASN paper: 71,9 (1) 8 ADR: 784,613 () New projection: 774,386 () 6 Actual: 7,8 (7) 4 of the overall ESRD population, even with moderations in disease rates. The growth of diabetes in both the general Medicare population and among younger patients is a concern as well. Figures.1 ; see page 36 for analytical methods. projected using a Markov model. ii Projected number of ESRD patient deaths through Number of deaths (in thousands) 1 1 8 6 4 JASN paper: 17,76 (1) New projection: 118,617 () Actual: 87,436 (7) 4 INCIDENCE & PREVAlENCE 9 USRDS Annual Data Report 8 84 88 9 96 4 8 1 16 8 84 88 9 96 4 8 1 16 Vol esrd Ch pg 33

n 7, the incident rate (adjusted for age, gender, and race) of end-stage renal disease fell.1 percent, to 34 per million population. This decline, the first since 199, brought the rate of new ESRD cases back to that seen in. Figure.3; see page 36 for analytical methods. Incident ESRD patients. I 4ii Geographic variations in adjusted incident rates (per million population), by HSA 1997 4 73 3 39 367 Adjusted incident rates & annual percent change 4 1 3 1 1 8 8 84 86 88 9 4 48 73 6ii 3 39 367 41 3 1, 1, 1, Ch pg 34-19 -44 4-64 6-74 7+ 8 84 88 9 96 4 7ii Incident counts & adjusted rates, by race 8 White African American Native American Asian 6 4 1, -19-44 4-64 6-74 7+ 4 98 8 Incident counts & adjusted rates, by age 96 9 6 4-6 White Af Am N Am Asian 3 8 84 88 9 96 4 73 3 39 367 41 Incident counts & adjusted rates, by Hispanic ethnicity 1 Non-Hispanic 7 Hispanic 6 ii 94 7 Incident counts & adjusted rates 9 Symbols: one-year % change Bars: 3ii Hispanic 4 3 Non-Hispanic 96 98 4 6

The incident rate among patients with Medicare Advantage (formerly Medicare + Choice) coverage peaked in 1, and by had fallen 6 percent, reaching 1,47 per million population 3 percent lower than the rate of,166 found in the fee-for-service population. More recent data are not yet available. Figure.9; see page 36 for analytical methods. Incident ESRD patients. The median age of the incident ESRD population has changed little since the late 199s, from a high of 6. in 1 to 64.4 in 7. By race and ethnicity, the median age ranges from 9.1 among African Americans to 66.8 among whites. Figure.1; see page 36 for analytical methods. Incident ESRD patients. In 7, the incident rate of ESRD was 34 per million population (see Table p.a), and geographically averaged 41 per million in the upper quintile 8.9 percent lower than in 1997. The highest adjusted rates occur in the southern and southwestern portions of the country, in areas along the Mississippi River, and through the Ohio Valley. Figure.4; see page 36 for analytical methods. Incident ESRD patients. 8 ii Incident counts & adjusted rates, by primary diagnosis Diabetes Hypertension 4 GN Cystic kidney 3 1 16 1 8 4 8 84 88 9 96 4 9ii Unadjusted incident rates, by payor,, 1, 1, Fee-for-service Medicare Advantage (Medicare + Choice) 93 9 97 99 1 3 Since, the adjusted incident rate of ESRD has grown 1.4 percent for patients age 7 and older, reaching 1,73 per million population in 7, while the rate for those age 44 has increased. percent, to 16. In the remaining adult age groups, in contrast, the rate has remained quite stable, with 7 levels.1 percent lower for those age 4 64, and 1. percent higher for those age 6 74. By race, incident rates for African Americans and Native Americans in 7 reached 998 and 49 per million population, respectively 3.7 and 1.8 times greater than the rate of 73 found among whites. Since, the rate of new ESRD cases has grown 4.6. percent for Asians and whites; among African Americans, in contrast, it has remained stable. 1 ii Median age of incident patients, by race/ethnicity Median age (in years) 7 6 White (7: 66.8) Af Am (9.1) N Am (8.) 4 Asian (61.7) Hispanic (6.1) (64.4) 3 78 8 86 9 94 98 6 Thirteen percent of new ESRD patients in 7 were Hispanic. The incident rate in this population fell from that seen in 6, to 8 per million population 1. times greater than that found among non-hispanics. Diabetes was the primary cause of ESRD for 4 percent of new patients in 7; one in three patients had a primary diagnosis of hypertension. The incident rate of diabetic ESRD fell 3.3 percent between 6 and 7, to 1 per million population just.6 percent greater than the rate seen in. The rate of ESRD caused by hypertension, in contrast, has grown 8. percent since, to 99 per million population, while ESRD due to glomerulonephritis has fallen 1.3 percent, to 4.3. Figures. 8; see page 36 for analytical methods. Incident ESRD patients. Incidence 4 INCIDENCE & PREVAlENCE 9 USRDS Annual Data Report Vol esrd Ch pg 3

11ii 1ii Geographic variations in adjusted prevalent rates (per million population), by HSA 1997 1,1 1,18 1,349 1, 1,686 Bars: A 1,8 18 1, 1 1, 1 9 9 6 6 3 3 8 8 84 86 88 9,177 1,1 1,18-19 -44 4-64 6-74 7+ 1 1 4, 3, Ch 1,349 1, 1,686 1,974 1, 8 84 88 9 96 4 98 4 1,13 1ii Prevalent counts & adjusted rates, by race White African American Native American Asian 3 1, -19-44 4-64 6-74 7+ 96 4, 3, White Af Am N Am Asian, 1, 1,18 4 6 8 84 88 9 96 4 1,349 1, 1,686 1,91 Prevalent counts & adjusted rates, by Hispanic ethnicity Non-Hispanic 4 3 1 Hispanic, pg 36 14ii 6, Prevalent counts & adjusted rates, by age 13ii 94 7 Prevalent counts & adjusted rates 9 djusted for age, gender, and race, the rate of prevalent ESRD cases rose. percent between 6 and 7, reaching 1,66 per million population. While this rate is nearly 18 percent greater than that seen in, the annual rate of growth has remained between. and.3 percent since 3. Figure.11; see page 36 for analytical methods. December 31 point prevalent patients. Adjusted prevalent rates & annual percent change Symbols: one-year % change Hispanic, 1, Non-Hispanic 1, 96 98 4 6

17ii 6 Median age (in years) he median age of the prevalent ESRD population has grown.7 percent since, reaching 9.1 in 7. By race and ethnicity, it varies from 7.1 in the African American population to 6.3 among whites. Figure.17; see page 36 for analytical methods. December 31 point prevalent patients. T I 16ii Prevalent counts & adjusted rates, by primary diagnosis Diabetes Hypertension Glomerulonephritis Cystic kidney 1 1 6 4 aii N Am (7.9) Asian (9.1) Hispanic (7.4) (9.1) 4 78 8 84 88 9 96 4 8 86 9 94 98 6 Adjusted incident & prevalent rates per million population, by metropolitan statistical area (MSA) & race/ethnicity, 7 (MSAs ranked by size; top three in each column highlighted in green) White New York, NY Los Angeles, CA Chicago, IL Dallas-Fort Worth, TX Philadelphia, PA Houston, TX Miami, FL Washington, DC Atlanta, GA Boston, MA Detroit, MI San Fran.-Oakland, CA Phoenix, AZ Riverside-San Bern., CA Seattle, WA Minneapolis-St Paul, MN San Diego, CA St. Louis, MO Tampa, FL Baltimore, MD Denver, CO Pittsburgh, PA Portland, OR Cleveland, OH Cincinnati, OH Inc 98 3 96 11 63 61 68 17 17 7 7 44 71 311 187 184 49 77 8 48 11 47 79 318 Prev 1,1 1,4 1,86 988 1,114 1,1 1,36 789 7 1, 1,169 1,191 1,13 1,34 91 1, 1,3 1,19 1,8 1,38 936 1,37 1,48 1,199 1,348 African American Other race Inc Prev Inc 864 84 946 83 1,3 949 91 789 781 78 1,78 94 86 741 744 8 8 1,184 98 1,18 698 1,481 98 993 1,11 he adjusted rate of prevalent ESRD cases among patients age 6 74 reached,87 per million population in 7 nearly 4 percent greater than in. For patients age 7 and older the rate is now,14, nearly 8 percent higher than in. Overall growth in the rate during the same period has been just 17. percent. By race, rates of prevalent ESRD continue to be highest in the African American and Native American populations, at,111 and,713 per million population, respectively, in 7, com- T 8 4 B White (7: 6.3) Af Am (7.1) 4,8 3,86 4,78 4,99,61 4,3 4,37 4,8 3,8 4,94,61,7 3,471 3,7 4,7,64 4,79 6,11,18,167 4,169 7,39 4,78,69 6,1 31 3 34 68 369 6 36 78 6 337 349 39 667 33 31 63 379 94 31 49 7 93 398 * 397 Prev 1,4 1,64 1,489 1,7 1,489 1,1 1,31 1,34 1,63 1,67 1,67,31 3,471 1,49 1,9 3,11 1,916 1,396 1,61 1,341 1,433 1,96 1,963 1,197 1,79 Hispanic Inc 4 9 3 443 64 43 37 44 7 376 3 439 88 488 36 48 14 47 48 48 3 * 34 * 61 Prev 1,786,496,97,6,69,4 1,13 1,73 81 1,86 1,948,4,446,18 1,7,76,78 4,1 1,61 1,88,3 1,17 1,838 1,,1 pared to 1, and 1,911 among whites and Asians. The rate for Hispanic patients reached,48 in 7, 1. times greater than the rate of 1,613 seen among non-hispanics. By primary diagnosis, annual growth in rates of existing ESRD cases continues to be relatively stable. In 7, rates for ESRD caused by cystic kidney disease, glomerulonephritis, hypertension, and diabetes reached 79, 6, 47, and 619 per million population, respectively. Figures.13 16; see page 36 for analytical methods. December 31 point prevalent patients. Prevalence 4 Incidence & prevalence 9 USRDS Annual Data Report n 7, the prevalent rate of ESRD was 1,66 per million population (see Table p.a), and averaged 1,91 per million population in the upper quintile. With the addition of high rates in the Dakotas, geographic patterns generally parallel those found in the incident population; the highest rates occur in the south and southwestern portions of the country. Figure.1; see page 36 for analytical methods. December 31 point prevalent patients. y MSA, the greatest adjusted rate of prevalent ESRD for whites occurs in the Los Angeles area, at 1,4 per million population. For African Americans, rates of 6, 7,4 are found in the St. Louis, Cincinnati, and Pittsburgh MSAs. The St. Louis MSA also has the highest prevalence among Hispanic patients, of 4,1. Table.a; see page 36 for analytical methods. Incident & December 31 point prevalent patients, 7. *Values for cells with ten or fewer patients are suppressed. Median age of prevalent patients, by race/ethnicity Vol esrd Ch pg 37

Growth in incident populations 18 ii Purple: Percent change, 1997 to 7 Purple: Percent change, 1997 to 7 Purple: Percent change, 1997 to 7 1 7 9 6 3 - Growth in incident ESRD due to diabetes, 1997 7, by network (adjusted rates) 1 3 4 6 7 8 9 1 11 1 13 14 1 16 17 18 ESRD network 19 ii Growth in incident ESRD due to hypertension, 1997 7, by network (adjusted rates) 1 3 4 6 7 8 9 1 11 1 13 14 1 16 17 18 ESRD network ii Growth in incident ESRD due to glomerulonephritis, 1997 7, by network (adjusted rates) 1 ii Incident patients 1 3 4 6 7 8 9 1 11 1 13 14 1 16 17 18 Geographic variations in mean age, 7, by HSA ESRD network Prevalent patients 9. 6.6 6.1 63. 64.9 66.7 6. 7.1 7.9 8.8 9. 6.4 1 1 1 1 4 - Green: Rate per million, 7 Green: Rate per million, 7 Green: Rate per million, 7 17/ 18 16 1 1 11 4 3 1 1 9 13 8 6 14 16 7 17 Network 1 Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont Network New York Network 3 New Jersey, Puerto Rico, Virgin Islands Network 4 Delaware, Pennsylvania Network Maryland, Virginia, Washington D.C., West Virginia Network 6 Georgia, North Carolina, South Carolina Network 7 Florida Network 8 Alabama, Mississippi, Tennessee Network 9 Indiana, Kentucky, Ohio Network 1 Illinois Network 11 Michigan, Minnesota, North Dakota, South Dakota, Wisconsin Network 1 Iowa, Kansas, Missouri, Nebraska Network 13 Arkansas, Louisiana, Oklahoma Network 14 Texas Network 1 Arizona, Colorado, Nevada, New Mexico, Utah, Wyoming Network 16 Alaska, Idaho, Montana, Oregon, Washington Network 17 American Samoa, Northern California, Guam, Hawaii Network 18 Southern California The overall adjusted rate of ESRD due to diabetes was 1 per million population in 7, 36 percent higher than a decade before. Both the highest rate and the greatest growth occurred in Network 14, at 193 per million and 3 percent, respectively. The rate of new ESRD cases due to hypertension rose only.6 percent in Network 1, but 7 percent in Network 1. And, with the exception of Network 16, rates of ESRD due to glomerulonephritis have fallen across the country. Figures.18 ; see page 36 for analytical methods. Incident ESRD patients. The mean age of both the incident and prevalent ESRD populations is greatest in areas of the Upper Midwest, the Northeast, and Florida. In the lower quintle, the mean age is 9. for incident patients, compared to 6. in the prevalent population. Means in the upper quintile are 66.7 and 6.4, respectively. Figure.1; see page 36 for analytical methods. Incident & December 31 point prevalent patients. Ch pg 38

b ii Patient demographics & adjusted rates, by ESRD network: incident dialysis patients, 7 Total % of Rate per Mean % % % % % % pts total million age DM White Af Am N Am Asian Hisp. 1 3,613 3.3 47.8 6. 4.3 8.8 14...8 7. 7,81 6. 36.3 64. 4. 61. 3.9.4 4.8 1.7 3 4,93 4. 4. 64..3 69.8 6.7. 3. 34. 4,31 4.9 394.6 64.9 43. 73.9 4.3. 1.6 3.3 6,.8 384.9 6. 41.4 48.6 47.8..6. 6 9,1 8.4 386.9 6.1 43. 41. 6.6.6 1.3. 7 6,83 6.3 364.1 63.8 41.9 66.8 31.. 1.4 1. 8,834.4 41.3 6.9 4.7 1. 48..4.. 9 8,496 7.8 376.9 63.9 44.4 7.8 3.4.1.6 1.8 1 4,78 4.4 36. 63.4 39. 63.4 33.3.1 3. 11.1 11 7,93 6.6 39.4 63.8 4.8 71.7 3... 3. 1 4,94 3.8 99.6 64. 43. 77. 1..9 1..9 13 4,6 4. 419.6 6.9 44. 3.1 41.3 4.6 1.. 14 8,77 8.1 39.6 6. 3.4 71.4.9.3.3 39.7 1 4,81 4. 48.3 61.. 79. 8.9 7.9 3.6.6 16 3,1.9 7.7 6.7 41.9 8.3 6.6 3. 7.4 7.4 17,16 4.8 34.4 6..1 7. 13.4.9 7.7.7 18 8,467 7.8 38. 6.3 46. 7.8 14.6.4 11.8 38.7 Unk. * 18,33 1. 34.7 6.7 44.6 6. 8.9 1.1 4. 13.7 c ii Patient demographics & adjusted rates, by ESRD network: December 31 point prevalent dialysis patients, 7 Total % of Rate per Mean % % % % % % pts total million age DM White Af Am N Am Asian Hisp. 1 11,93 3. 89 64. 39.4 7..3.3 3.1 8.7 4,4 6.6 1,6 6. 4.7 1. 4.8.. 14.7 3 1,136 4.1 1, 6. 46.1 8. 33.9.1 3. 3.1 4 16,141 4.4 1,18 63.1 41. 6. 3.4.1 1. 3.6 1,7.9 1,39 6.4 39.6 36.4 9.8..6 3.1 6 3,39 9.6 1,47 8.6 41.1 3. 67.4.6 1.1.6 7,889.7 1,9 61. 39.9. 41..3 1.9 1.3 8,736.6 1,468 9.1 4.4 37.8 61....8 9 6,6 7. 1,173 61.9 43. 64.8 34.1.1.7. 1 1,71 4.3 1,191 61.7 39.9 4.1 4.1. 3. 1. 11,9 6. 997 6.6 41.3 6. 3. 3..3 3.7 1 13,47 3.6 974 6. 4.1 67.6 9.9 1.1 1.. 13 14,643 4. 1,331 8.9 4.3 4.1 1.6 4.9 1..6 14 33,9 9. 1,39 8.9.4 66.3 3.6.3. 43. 1 16,86 4.6 84 6.7. 71. 1.9 13.6 3.9 9.1 16 9,88.7 713 61.3 4.1 77.3 9. 4.7 8.7 9.4 17 19,198. 1,189 61. 48.1 49.9 16.4.9 3.9 1.9 18 3,36 8. 1,7 6. 4.6 69.3 16.6. 1.7 44.7 Unk. * 368,44 1. 1,163 6.9 43..7 37.1 1. 4.7 1.6 d ii Patient demographics & adjusted rates, by ESRD network: December 31 point prevalent transplant patients, 7 Total % of Rate per Mean % % % % % % pts total million age DM White Af Am N Am Asian Hisp. 1 7,81 4.9 1.9 1.4.1 8.9 11.8.3 3.9 7.4 1,9 6.4 496.1.6 19. 67.4.4.8 6. 16.8 3 4,44.8 4.4.8. 71.4.4. 4.8 3.1 4 9,43.9 677. 1.6. 73.4 1.. 3.4 3. 9,776 6. 9.7 1.1. 7. 3..3 4.8 4.7 6 9,67.8 389.9 49.8.6 8. 38.3.8.3.1 7 8,7. 419.. 1. 7.3.. 3. 16.9 8 7,371 4.6 4. 49.4.8 6. 3.9.3 1.4 1. 9 11,389 7. 499.8.4.8 8.3 16.6.1. 1.6 1 6,97 4.4 7.7 49.7.6 67..4.3 4.6 13.7 11 17,41 11. 77.9 1. 8.4 8.1 1.4 1.8 3.1 3. 1 7,344 4.6 33.7.7.7 8.8 13.8.8. 4.8 13 4,793 3. 43.9 49.9 3.6 63.1 31.4 3. 1.8.4 14 1,747 6.8 44. 49.6 4.6 77.8 16.4.4 3.9 36.8 1 8,37.1 413.1.3 8.1 84.3.1 6. 4.1.4 16,937 3.7 43.3 1.3 4.9 83.9.4.8 7.6 6.8 17 8,31. 8.6.4.9 6.1 8.8.9 3..3 18 11,41 7. 476. 49.3 19.9 73. 11.1.6 13.9 37. Unk. 4. 46.4. 1.7 1.7.9.7. 18,739 1..3. 3.1 73.1 19. 1.1.4 1.7 These tables present patient demographics and adjusted disease rates by modality and ESRD network. With an overall incident rate for dialysis patients of 346 per million population in 7, rates by network range from 8 in Network 16 to 4 in Network 13. The distribution of patients by race continues to vary widely across the country. African Americans, for instance, constitute just 6.6 percent of the new ESRD population in Network 16, but 48 7 percent of patients in Networks, 6, and 8. In the prevalent population, the overall rate for point prevalent dialysis patients in 7 was 1,163 per million population. Network 1 has the lowest percentage of patients with diabetic ESRD, at 39.4, compared to percent in Networks 14 and 1. The rate of point prevalent ESRD patients with a transplant is lowest in Network 6, at 39 per million population. In Network 11, in contrast, the rate reaches 78 1 percent greater than the next highest rate, found in Network 4. One in nine transplant patients in the U.S. resides in one of the Upper Midwestern states covered by Network 11. Tables.b d; see page 36 for analytical methods. Incident dialysis patients (.b); December 31 point prevalent dialysis patients (.c); December 31 point prevalent transplant patients (.d). *Values for cells with ten or fewer patients are suppressed. Network populations 4 INCIDENCE & PREVAlENCE 9 USRDS Annual Data Report Vol esrd Ch pg 39

summary chapter In 7, the adjusted rate of new ESRD cases was 34 per million population..3 The rate of new ESRD cases among African Americans reached 998 per million population in 7 3.7 times greater than the rate of 73 among whites..6 Hispanics accounted for 13% of new ESRD patients in 7. At 8 per million population, their rate was 1. times greater than that of non-hispanics..7 In 7, diabetes was the cause of ESRD in 4% of new patients; one in three had ESRD caused by hyppertension..8 The adjusted rate of prevalent ESRD cases reached 1,66 per million population in 7..11 The rate of prevalent ESRD cases among patients age 6 74 reached,879 in 7 nearly 4% greater than in..13 The rate of,111 prevalent ESRD cases per million population among African Americans is 4. times greater than the rate of 1,31 among whites..14 With an overall incident rate for dialysis patients of 346 per million population in 7, rates by network range from 8 in Network 16 to 4 in Network 13..b One in nine transplant patients in the U.S. resides in an Upper Midwestern state covered by Network 11..d summary Ch pg 4