Influence of race, ethnicity and socioeconomic status on kidney disease

Patzer, Rachel E.; McClellan, William

doi:10.1038/nrneph.2012.117

Cited by 203 publications

(167 citation statements)

References 122 publications

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“…27 In the Kidney Early Evaluation Program, persons without health insurance had a 72% greater risk of ESRD (and 82% greater risk of all-cause mortality) than persons with private health insurance. 28 In our study, participants without health insurance (as well as those participants with lower reported annual income) were more likely to list the emergency department as a usual source of medical care and had, on average, higher numbers of hospitalizations.…”

Section: Discussionmentioning

confidence: 99%

Explaining the Racial Difference in AKI Incidence

Grams

Matsushita²,

Sang³

et al. 2014

Journal of the American Society of Nephrology

131

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African Americans face higher risk of AKI than Caucasians. The extent to which this increased risk is because of differences in clinical, socioeconomic, or genetic risk factors is unknown. We evaluated 10,588 African-American and Caucasian participants in the Atherosclerosis Risk in Communities study, a community-based prospective cohort of middle-aged individuals. Participants were followed from baseline study visit (1996)(1997)(1998)(1999) to first hospitalization for AKI (defined by billing code), ESRD, death, or December 31, 2010. African-American participants were slightly younger (61.7 versus 63.1 years, P,0.001), were more often women (64.5% versus 53.2%, P,0.001), and had higher baseline eGFR compared with Caucasians. Annual family income, education level, and prevalence of health insurance were lower among African Americans than Caucasians. The unadjusted incidence of hospitalized AKI was 7.4 cases per 1000 person-years among African Americans and 5.8 cases per 1000 person-years among Caucasians (P=0.002). The elevated risk of AKI among African Americans persisted after adjustment for demographics, cardiovascular risk factors, kidney markers, and time-varying number of hospitalizations (adjusted hazard ratio, 1.20; 95% confidence interval [95% CI], 1.01 to 1.43; P=0.04); however, accounting for differences in income and/or insurance by race attenuated the association (P.0.05). High-risk APOL1 variants did not associate with AKI among African Americans (demographic-adjusted hazard ratio, 1.07; 95% CI, 0.69 to 1.65; P=0.77). In summary, the higher risk of AKI among African Americans may be related to disparities in socioeconomic status.

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Section: Discussionmentioning

confidence: 99%

Explaining the Racial Difference in AKI Incidence

Grams

Matsushita²,

Sang³

et al. 2014

Journal of the American Society of Nephrology

131

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“…A sensitivity analysis indicated that exclusion of race and sex from patient case mix had minimal effect on the STReR estimates, and the classification of STReRs from the two models agreed in 99% of cases. We decided a priori not to consider any socioeconomic indicators, such as health insurance or neighborhood poverty, in the risk adjustment, because we did not believe that dialysis facilities should restrict access to referral on the basis of social factors that are associated with widespread disparities in transplant access (27). Our sensitivity analyses showed that patients with employer-based health insurance are more likely to be referred than those with Medicare, suggesting that socioeconomic status factors do play a role in referral for transplantation at dialysis facilities.…”

Section: Discussionmentioning

confidence: 99%

Standardized Transplantation Referral Ratio to Assess Performance of Transplant Referral among Dialysis Facilities

Paul

Plantinga

Pastan

et al. 2018

CJASN

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Background and objectives For patients with ESRD, referral from a dialysis facility to a transplant center for evaluation is an important step toward kidney transplantation. However, a standardized measure for assessing clinical performance of dialysis facilities transplant access is lacking. We describe methodology for a new dialysis facility measure: the Standardized Transplantation Referral Ratio.Design, setting, participants, & measurements Transplant referral data from 8308 patients with incident ESRD within 249 dialysis facilities in the United States state of Georgia were linked with US Renal Data System data from January of 2008 to December of 2011, with follow-up through December of 2012. Facility-level expected referrals were computed from a two-stage Cox proportional hazards model after patient case mix risk adjustment including demographics and comorbidities. The Standardized Transplantation Referral Ratio (95% confidence interval) was calculated as a ratio of observed to expected referrals. Measure validity and reliability were assessed.Results Over 2008-2011, facility Standardized Transplantation Referral Ratios in Georgia ranged from 0 to 4.87 (mean =1.16, SD=0.76). Most (77%) facilities had observed referrals as expected, whereas 11% and 12% had Standardized Transplantation Referral Ratios significantly greater than and less than expected, respectively. Age, race, sex, and comorbid conditions were significantly associated with the likelihood of referral, and they were included in risk adjustment for Standardized Transplantation Referral Ratio calculations. The Standardized Transplantation Referral Ratios were positively associated with evaluation, waitlisting, and transplantation (r=0.46, 0.35, and 0.20, respectively; P,0.01). On average, approximately 33% of the variability in Standardized Transplantation Referral Ratios was attributed to between-facility variation, and 67% of the variability in Standardized Transplantation Referral Ratios was attributed to within-facility variation.Conclusions The majority of observed variation in dialysis facility referral performance was due to characteristics within a dialysis facility rather than patient factors included in risk adjustment models. Our study shows a method for computing a facility-level standardized measure for transplant referral on the basis of a pilot sample of Georgia dialysis facilities that could be used to monitor transplant referral performance of dialysis facilities.

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“…Household income is an important socioeconomic determinant of health, with several studies outlining inferior health outcomes in lower-income groups, including a higher risk of diabetes, coronary artery disease, obesity, psychiatric illness, and, importantly, ESRD. [8][9][10][11][12][13][14] Furthermore, high-risk behaviors, such as tobacco and substance abuse, are more common in lower-income populations and social support networks may be poorer in these groups. 12,14 As a result, prospective donors from low-income populations may frequently be found medically unsuitable to donate a kidney.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Race and Income on Living Kidney Donation in the United States

Gill

Dong

Rose

et al. 2013

Journal of the American Society of Nephrology

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Studies of racial disparities in access to living donor kidney transplantation focus mainly on patient factors, whereas donor factors remain largely unexamined. Here, data from the US Census Bureau were combined with data on all African-American and white living kidney donors in the United States who were registered in the United Network for Organ Sharing (UNOS) between 1998 and 2010 (N=57,896) to examine the associations between living kidney donation (LKD) and donor median household income and race. The relative incidence of LKD was determined in zip code quintiles ranked by median household income after adjustment for age, sex, ESRD rate, and geography. The incidence of LKD was greater in higher-income quintiles in both African-American and white populations. Notably, the total incidence of LKD was higher in the African-American population than in the white population (incidence rate ratio [IRR], 1.20; 95% confidence interval [95% CI], 1.17 to 1.24]), but ratios varied by income. The incidence of LKD was lower in the African-American population than in the white population in the lowest income quintile (IRR, 0.84; 95% CI, 0.78 to 0.90), but higher in the African-American population in the three highest income quintiles, with IRRs of 1.31 (95% CI, 1.22 to 1.41) in Q3, 1.50 (95% CI, 1.39 to 1.62) in Q4, and 1.87 (95% CI, 1.73 to 2.02) in Q5. Thus, these data suggest that racial disparities in access to living donor transplantation are likely due to socioeconomic factors rather than cultural differences in the acceptance of LKD.

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Influence of race, ethnicity and socioeconomic status on kidney disease

Cited by 203 publications

References 122 publications

Explaining the Racial Difference in AKI Incidence

Explaining the Racial Difference in AKI Incidence

Standardized Transplantation Referral Ratio to Assess Performance of Transplant Referral among Dialysis Facilities

The Effect of Race and Income on Living Kidney Donation in the United States

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