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Negligible impact of differential item functioning between Black and White dialysis patients on the Kidney Disease Quality of Life 36-item short form survey (KDQOLTM-36)

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Abstract

Purpose

Black dialysis patients report better health-related quality of life (HRQOL) than White patients, which may be explained if Black and White patients respond systematically differently to HRQOL survey items.

Methods

We examined differential item functioning (DIF) of the Kidney Disease Quality of Life 36-item (KDQOLTM-36) Burden of Kidney Disease, Symptoms and Problems with Kidney Disease, and Effects of Kidney Disease scales between Black (n = 18,404) and White (n = 21,439) dialysis patients. We fit multiple group confirmatory factor analysis models with increasing invariance: a Configural model (invariant factor structure), a Metric model (invariant factor loadings), and a Scalar model (invariant intercepts). Criteria for invariance included non-significant χ2 tests, > 0.002 difference in the models’ CFI, and > 0.015 difference in RMSEA and SRMR. Next, starting with a fully invariant model, we freed loadings and intercepts item-by-item to determine if DIF impacted estimated KDQOLTM-36 scale means.

Results

ΔCFI was 0.006 between the metric and scalar models but was reduced to 0.001 when we freed intercepts for the burdens and symptoms and problems of kidney disease scales. In comparison to standardized means of 0 in the White group, those for the Black group on the Burdens, Symptoms and Problems, and Effects of Kidney Disease scales were 0.218, 0.061, and 0.161, respectively. When loadings and thresholds were released sequentially, differences in means between models ranged between 0.001 and 0.048.

Conclusion

Despite some DIF, impacts on KDQOLTM-36 responses appear to be minimal. We conclude that the KDQOLTM-36 is appropriate to make substantive comparisons of HRQOL between Black and White dialysis patients.

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Abbreviations

AV:

Arteriovenous

CFA:

Confirmatory factor analysis

CFI:

Comparative fit index

CMS:

Centers for Medicare and Medicaid Services

DIF:

Differential item functioning

DOPPS:

Dialysis outcomes and practice patterns study

ESRD:

End-stage renal disease

HRQOL:

Health-related quality of life

KDCS:

Kidney Disease Component Summary

KDQOL-36:

Kidney Disease Quality of Life 36-item survey

KDQOL-SF:

KDQOL-short form

MCS:

Mental Component Summary

PCS:

Physical Component Summary

PD:

Peritoneal dialysis

RMSEA:

Root mean squared error of approximation

SRMR:

Standardized root mean square residual

US:

United States

WLSMV:

Weighted least squares with mean and variance adjustment

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Acknowledgements

We are grateful to Dori Schatell and Ryne Estabrook for their insightful suggestions on this manuscript. There was no direct financial support for the research reported in this manuscript.

Funding

This study was not funded.

Author information

Authors and Affiliations

  1. Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Ave., Suite 2700, Chicago, IL, 60611, USA

    John D. Peipert

  2. Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA

    John D. Peipert

  3. Terasaki Research Institute, University of California, Los Angeles, Los Angeles, CA, USA

    John D. Peipert

  4. Departments of Psychology and Statistics, University of California, Los Angeles, Los Angeles, CA, USA

    Peter Bentler

  5. Medical Education Institute, Inc., Madison, WI, USA

    Kristi Klicko

  6. Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, CA, USA

    Ron D. Hays

Authors
  1. John D. Peipert
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  2. Peter Bentler
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  3. Kristi Klicko
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  4. Ron D. Hays
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Correspondence to John D. Peipert.

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Peipert, J.D., Bentler, P., Klicko, K. et al. Negligible impact of differential item functioning between Black and White dialysis patients on the Kidney Disease Quality of Life 36-item short form survey (KDQOLTM-36). Qual Life Res 27, 2699–2707 (2018). https://doi.org/10.1007/s11136-018-1879-3

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  • DOI: https://doi.org/10.1007/s11136-018-1879-3

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