Racial Composition of Residential Areas Associates with Access to Pre-ESRD Nephrology Care

Prakash, Suma; Rodriguez, Rudolph A.; Austin, Peter C.; Saskin, Refik; Fernández, Alicia; Moist, Louise; O’Hare, Ann M.

doi:10.1681/asn.2009101008

Cited by 61 publications

(72 citation statements)

References 45 publications

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“…15 Second, two separate studies have shown that patients who live in black majority communities or are treated in facilities located in such communities are significantly less likely to have received predialysis nephrology care. 16,17 No such data are available for other racial/ethnic groups. The need to ensure equitable access to home dialysis is even more urgent now as the use of both PD and home HD are seeing unprecedented and rapid growth, and these racial/ethnic differences need additional investigation.…”

Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Disparities in Use of and Outcomes with Home Dialysis in the United States

Mehrotra

Soohoo

Rivara

et al. 2015

JASN

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Home dialysis, which comprises peritoneal dialysis (PD) or home hemodialysis (home HD), offers patients with ESRD greater flexibility and independence. Although ESRD disproportionately affects racial/ethnic minorities, data on disparities in use and outcomes with home dialysis are sparse. We analyzed data of patients who initiated maintenance dialysis between 2007 and 2011 and were admitted to any of 2217 dialysis facilities in 43 states operated by a single large dialysis organization, with follow-up through December 31, 2011 (n=162,050, of which 17,791 underwent PD and 2536 underwent home HD for $91 days). Every racial/ethnic minority group was significantly less likely to be treated with home dialysis than whites. Among individuals treated with in-center HD or PD, racial/ethnic minorities had a lower risk for death than whites; among individuals undergoing home HD, only blacks had a significantly lower death risk than whites. Blacks undergoing PD or home HD had a higher risk for transfer to in-center HD than their white counterparts, whereas Asians or others undergoing PD had a lower risk than whites undergoing PD. Blacks irrespective of dialysis modality, Hispanics undergoing PD or in-center HD, and Asians and other racial groups undergoing in-center HD were significantly less likely than white counterparts to receive a kidney transplant. In conclusion, there are racial/ethnic disparities in use of and outcomes with home dialysis in the United States. Disparities in kidney transplantation evident for blacks and Hispanics undergoing home dialysis are similar to those with in-center HD. Future studies should identify modifiable causes for these disparities.

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Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Disparities in Use of and Outcomes with Home Dialysis in the United States

Mehrotra

Soohoo

Rivara

et al. 2015

JASN

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“…Prior reports suggest that sociodemographic differences may have important influences on chronic disease through mediators such as chronic stress, psychosocial factors (i.e., pessimism and low self-esteem), 21 acculturation, 22 environmental pollution, 23 or differences in access to care. 24,25 Whether or not these factors and their interaction with genetic predisposition may also explain race/ethnic differences in early kidney function decline will be an important area for future study.…”

Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Differences in Kidney Function Decline among Persons without Chronic Kidney Disease

Peralta

Katz

DeBoer

et al. 2011

Journal of the American Society of Nephrology

122

104

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Whether the rate of kidney function decline before the onset of CKD differs among racial and ethnic groups remains unclear. Here, we evaluated kidney function decline and incident CKD among white, black, Hispanic, and Chinese participants in the Multi-Ethnic Study of Atherosclerosis (MESA) during 5 years of follow-up. We estimated GFR using both cystatin C (eGFRcys) and creatinine (eGFRcreat). The definition of incident CKD required eGFRcys Ͻ60 ml/min per 1.73 m 2 and a decline in eGFRcys Ն1 ml/min per year. Among participants with eGFRcreat Ͼ60 ml/min per 1.73 m 2 at baseline, blacks had a significantly higher rate of kidney function decline than whites (0.31 ml/min per 1.73 m 2 /yr faster on average, P ϭ 0.001), even after adjusting for multiple potential confounders. Among Hispanics, Dominicans and Puerto Ricans had faster rates of decline than whites (0.55 and 0.47 ml/min per 1.73 m 2 /yr faster, respectively). Mexicans, South Americans, or other Hispanics had similar rates of decline compared to whites. We did not detect significant differences in the rates of kidney function decline among Chinese and white participants. Among those with normal or near-normal kidney function at baseline, blacks and Hispanics had the highest rates of incident CKD during follow-up. Adjustment for comorbidities attenuated some of these differences. In conclusion, the average rate of kidney function decline before the onset of CKD differs among racial and ethnic groups. Traditional risk factors do not explain these differences fully, highlighting the need to explore these disparities.

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“…Although the receipt of nephrologist care is influenced by individual as well as contextual factors such as those related to residence, prior studies have mostly examined individual factors (12,(19)(20)(21), or the few studies that examined contextual factors have generally examined them separately (22)(23)(24) or were limited to certain regional areas (15,25). An important knowledge gap exists regarding broad regional (e.g., state-level) differences in the utilization of nephrologist care among patients with CKD stages 4-5.…”

Section: Introductionmentioning

confidence: 99%

Interstate Variation in Receipt of Nephrologist Care in US Patients Approaching ESRD

Gao

Cheung

Greene

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Although multiple factors influence access to nephrologist care in patients with CKD stages 4-5, the geographic determinants within the United States are incompletely understood. In this study, we examined interstate differences in nephrologist care among patients approaching ESRD.Design, setting, participants, & measurements This national, population-based analysis included 373,986 adult patients from the US Renal Data System, who initiated maintenance dialysis between 2005 and 2009. Multilevel logistic regression was used to examine interstate variation in nephrologist care ($12 months before ESRD) for overall and four race-age subpopulations (black or white and older or younger than 65 years). ResultsThe average state-level probability of having received nephrologist care in all states combined was 28.8% (95% confidence interval, 25.2% to 32.7%) overall and was lowest (24.3%) in the younger black subpopulation. Even at these lower levels, state-level probabilities varied considerably across states in overall and subpopulations (all P,0.001). Overall, excluding the states in the upper and lower five percentiles, the remaining states had a probability of receiving care that varied from 18.5% to 41.9%. The lower probability of receiving nephrologist care for blacks than whites among younger patients noted in most states was attenuated in older patients. Geographically, all New England states and most Midwest states had higher than average probability, whereas most Middle Atlantic and Southern states had lower than average probability. After controlling for patient factors, three state-characteristic categories, including general healthcare access measured by percentage of uninsured persons and Medicaid program performance scores, preventive care measured by percentage of receiving recommended preventive care, and socioeconomic status, contributed 55%-66% of interstate variation.Conclusions Patients living in states with better health service and socioeconomic characteristics were more likely to receive predialysis nephrologist care. The reported national black-white difference in nephrologist care was primarily driven by younger black patients being the least likely to receive care.

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Racial Composition of Residential Areas Associates with Access to Pre-ESRD Nephrology Care

Cited by 61 publications

References 45 publications

Racial and Ethnic Disparities in Use of and Outcomes with Home Dialysis in the United States

Racial and Ethnic Disparities in Use of and Outcomes with Home Dialysis in the United States

Racial and Ethnic Differences in Kidney Function Decline among Persons without Chronic Kidney Disease

Interstate Variation in Receipt of Nephrologist Care in US Patients Approaching ESRD

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