Health Literacy Mediates Racial Disparities in Cardiopulmonary Resuscitation Knowledge among Chronic Kidney Disease Patients

Eneanya, Nwamaka D.; Olaniran, Kabir O.; Xu, Dihua; Waite, Katherine; Crittenden, Stanley; Hazar, Derya Bora; Volandes, Angelo E.; Temel, Jennifer S.; Thadhani, Ravi

doi:10.1353/hpu.2018.0080

Cited by 19 publications

(21 citation statements)

References 41 publications

(38 reference statements)

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“… 25 Lower rates of patient activation (ie, confidence to engage in health care and treatment decisions among marginalized patients) because of frequent and recurrent inequitable treatment by the health system may play a role in the demonstrated differences in paroxysmal AF management. 26 , 27 …”

Section: Discussionmentioning

confidence: 99%

Racial/Ethnic and Socioeconomic Disparities in Management of Incident Paroxysmal Atrial Fibrillation

et al. 2021

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IMPORTANCE In patients with paroxysmal atrial fibrillation (AF), rhythm control with either antiarrhythmic drugs (AADs) or catheter ablation has been associated with decreased symptoms, prevention of adverse remodeling, and improved cardiovascular outcomes. Adoption of advanced cardiovascular therapeutics, however, is often slower among patients from racial/ethnic minority groups and those with lower income. OBJECTIVE To ascertain the cumulative rates of AAD and catheter ablation use for the management of paroxysmal AF and to investigate for the presence of inequities in AF management by evaluating the association of race/ethnicity and socioeconomic status with their use in the United States. DESIGN, SETTING, AND PARTICIPANTS This cohort study obtained inpatient, outpatient, and pharmacy claims data from the Optum Clinformatics Data Mart between October 1, 2015, and June 30, 2019. Adult patients (aged Ն18 years) in the database with a diagnosis of incident paroxysmal AF were identified. Patients were excluded if they did not have continuous insurance enrollment for at least 1 year before and at least 6 months after study entry. EXPOSURES Race/ethnicity and zip code-linked median household income. MAIN OUTCOMES AND MEASURES Treatment with a rhythm control strategy, and catheter ablation specifically, among those who received rhythm control. Multivariable logistic regression models were used to assess the association of race/ethnicity and zip code-linked median household income with a rhythm control strategy (AADs or catheter ablation) vs a rate control strategy as well as with catheter ablation vs AADs among those receiving rhythm control. RESULTS Of the 109 221 patients who met the inclusion criteria, 55 185 were men (50.5%) and 73 523 were White (67.3%), with a median (interquartile range) age of 75 (68-82) years. A total of 86 359 patients (79.1%) were treated with rate control, 19 362 patients (17.7%) with AADs, and 3500 (3.2%) with catheter ablation. Between 2016 and 2019, the cumulative percentage of patients treated with catheter ablation increased from 1.6% to 3.8%. In multivariable analyses, Black race

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Section: Discussionmentioning

confidence: 99%

Racial/Ethnic and Socioeconomic Disparities in Management of Incident Paroxysmal Atrial Fibrillation

et al. 2021

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“…LHL was associated with worse control of blood pressure [ 55 , 61 ], lower medication adherence confidence [ 44 , 53 ] and lower quality of life [ 56 ]. For worse treatment and self-care knowledge [ 7 , 41–43 , 49 , 52 , 53 , 79 ], worse self-care behaviours [ 7 , 40 , 43 , 51 , 55 ], including lifestyle [ 40 , 50 , 51 ] and adherence problems [ 8 , 38 , 46 , 51 , 53 ] some studies found an association with LHL, while others did not. LHL was not associated with CKD awareness [ 33 , 47 ], treatment preferences [ 67 ], disaster preparedness [ 57 ] and phosphate regulation [ 54 ].…”

Section: Resultsmentioning

confidence: 99%

“…A potential explanation for our weak evidence could lie in our separate assessment of various mediating factors, instead of lumping them together. For example, we found separate associations of LHL with knowledge of medication [ 44 , 46 ], lifestyle [ 7 ], disease [ 42 ], transplant [ 44 , 49 ] and cardiopulmonary resuscitation [ 52 ]. We think that these factors are too heterogeneous to combine validly.…”

Section: Discussionmentioning

confidence: 99%

How to tackle health literacy problems in chronic kidney disease patients? A systematic review to identify promising intervention targets and strategies

Boonstra

Reijneveld

Foitzik

et al. 2020

Nephrology Dialysis Transplantation

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Background Limited health literacy (LHL) is associated with multiple adverse health outcomes in chronic kidney disease (CKD). Interventions are needed to improve this situation, but evidence on intervention targets and strategies is lacking. This systematic review aims to identify potential targets and strategies by summarizing the evidence on: (i) patient- and system-level factors potentially mediating the relation between LHL and health outcomes; and (ii) the effectiveness of health literacy interventions customized to CKD patients. Methods We performed a systematic review of peer-reviewed research articles in Medline, Embase and Web of Science, 2009–19. We assessed the quality of the studies and conducted a best-evidence synthesis. Results We identified 860 publications and included 48 studies. Most studies were of low quality (n = 26) and focused on dialysis and transplantation (n = 38). We found strong evidence for an association of LHL with smoking and having a suboptimal transplantation process. Evidence was weak for associations between LHL and a variety of factors related to self-care management (n = 25), utilization of care (n = 23), patient–provider interaction (n = 8) and social context (n = 5). Six interventions were aimed at improving knowledge, decision-making and health behaviours, but evidence for their effectiveness was weak. Conclusions Study heterogeneity, low quality and focus on kidney failure largely impede the identification of intervention targets and strategies for LHL. More and higher quality studies in earlier CKD stages are needed to unravel how LHL leads to worse health outcomes, and to identify targets and strategies to prevent disease deterioration. Healthcare organizations need to develop and evaluate efforts to support LHL patients.

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“…This compared with a 46% and 22% higher risk of death and DNR utilization, respectively, among other race/ethnicities. Although lower DNR utilization might reflect less advance care planning among Black patients, [16][17][18][19][20] including those with kidney disease, 21,22 we have also recently used the same Philips Healthcare data set to demonstrate racial disparities in critical care access. 23 Accordingly, the effect of prehospital practices, such as primary care 24,25 and health literacy, 26 versus the effect of within hospital practices, such as the counseling of admitting physicians, on resuscitation orders is uncertain.…”

Section: Discussionmentioning

confidence: 99%

Use of Do-Not-Resuscitate Orders for Critically Ill Patients with ESKD

Danziger

Hoz

Celi

et al. 2020

JASN

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BackgroundDespite having high comorbidity rates and shortened life expectancy, patients with ESKD may harbor unrealistically optimistic expectations about their prognoses. Whether this affects resuscitation orders is unknown.MethodsTo determine whether do-not-resuscitate (DNR) orders differ among patients with ESKD compared with other critically ill patients, including those with diseases of other major organs, we investigated DNR orders on admission to intensive care units (ICUs) among 106,873 patients in the United States.ResultsMajor organ disease uniformly associated with increased risk of hospital mortality, particularly for cirrhosis (adjusted odds ratio [aOR], 2.67; 95% confidence interval [95% CI], 2.30 to 3.08), and ESKD (aOR, 1.47; 95% CI, 1.31 to 1.65). Compared with critically ill patients without major organ disease, patients with stroke, cancer, heart failure, dementia, chronic obstructive pulmonary disease, and cirrhosis were statistically more likely to have a DNR order on ICU admission; those with ESKD were not. Findings were similar when comparing patients with a single organ disease with those without organ disease. The disconnect between prognosis and DNR use was most notable among Black patients, for whom ESKD (compared with no major organ disease) was associated with a 62% (aOR, 1.62; 95% CI, 1.27 to 2.04) higher odds of hospital mortality, but no appreciable difference in DNR utilization (aOR, 1.06; 95% CI, 0.66 to 1.62).ConclusionsUnlike patients with diseases of other major organs, critically ill patients with ESKD were not more likely to have a DNR order than patients without ESKD. Whether this reflects a greater lack of advance care planning in the nephrology community, as well as a missed opportunity to minimize potentially needless patient suffering, requires further study.

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Health Literacy Mediates Racial Disparities in Cardiopulmonary Resuscitation Knowledge among Chronic Kidney Disease Patients

Cited by 19 publications

References 41 publications

Racial/Ethnic and Socioeconomic Disparities in Management of Incident Paroxysmal Atrial Fibrillation

Racial/Ethnic and Socioeconomic Disparities in Management of Incident Paroxysmal Atrial Fibrillation

How to tackle health literacy problems in chronic kidney disease patients? A systematic review to identify promising intervention targets and strategies

Use of Do-Not-Resuscitate Orders for Critically Ill Patients with ESKD

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