The association of neighborhood racial mix and ED visit count in a cohort of patients on hemodialysis

Abstract

Background Neighborhood racial mix is associated with dialysis facility performance metrics and mortality outcomes in patients on hemodialysis. We explored the association of neighborhood racial mix with emergency department (ED) visits in patients receiving hemodialysis. Methods Using Looking Glass (Montefiore’s clinical database) we identified a cohort of patients on hemodialysis with an index ED visit at any of 4 Montefiore Hospital locations, between January 2013 and December 2017 and followed it for number of ED visits through December of 2017 or dropout due to death. The racial mix data for the Bronx block group of each subject’s residence was derived from the Census Bureau. We then used negative binomial regression to test the association of quintile of percent of Black residents per residential block group with ED visits in unadjusted and adjusted models. To adjust further for quality offered by local dialysis facilities, with the facility zip code as the locus, we used data from the “Dialysis Compare” website. Results Three thousand nine-hundred and eighteen subjects were identified and the median number of ED visits was 3 (interquartile range (IQR) 1–7) during the study period. Subjects living in the highest quintile of percent Black residents were older, more commonly female and had lower poverty rates and higher rates of high school diplomas. Unadjusted models showed a significant association between the highest quintiles of Black neighborhood residence and count of ED visits. Fully adjusted, stratified models revealed that among males, and Hispanic and White subjects, living in neighborhoods with the highest quintiles of Black residents was associated with significantly more ED visits (p-trend =0.001, 0.02, 0.01 respectively). No association was found between dialysis facility locations’ quintile of Black residents and quality metrics. Conclusions Living in a neighborhood with a higher percentage of Black residents is associated with a higher number of ED visits in males and non-Black patients on hemodialysis. Electronic supplementary material The online version of this article (10.1186/s12882-019-1520-x) contains supplementary material, which is available to authorized users.

Lower-extremity Arterial Thrombosis Associated with COVID-19 Is Characterized by Greater Thrombus Burden and Increased Rate of Amputation and Death

“…Medical records were reviewed for COVID-19 status (based on RT-PCR testing of nasopharyngeal samples), demographics (age and sex), socioeconomic status expressed as standard deviations from the New York State mean income based on census tract data ( 20 ), lab tests, history of PVD, presenting symptoms, ICU stay and outcomes of death or leg amputation. Diagnostic test used to detect SARS-CoV-2 infection was recorded.…”

The Role of Place in Disparities Affecting Black Men Receiving Hemodialysis

“…Thus the IRR represented in this manuscript is similar to the range of reported associations for other clinical and demographic factors that are associated with dialysis related hospitalization and/or mortality. 29 We observed that those receiving treatment in communities with substantial proportions of Black residents had fewer comorbidities, had lower rates of AVF use, and shorter dialysis sessions.…”

“…33,34,43,44 In previous studies, Black men living in communities with sizable Black populations were shown to have lower access to pre-ESKD nephrology care, and experience lower quality of dialysis treatments, both of which were thought to mediate their worse outcomes. 29,45 Furthermore, Black men have been shown to suffer from multiple structural inequities that amplify the adverse impact of economic disadvantage on their health outcomes, and thus may not be able overcome this disadvantage by relying solely on the higher social capital and support they may receive within communities with substantial proportions of Black residents. 16,17 Thus, Black men in communities with sizable Black populations appear especially vulnerable to the socioeconomic attributes of their communities with respect to their health outcomes.…”

Health inequities in dialysis care: A scoping review

“…54 Education was not a predictor of fatigue symptoms, 74 hospital outcomes, or dialysis facility ratings. 55 In a patient survey conducted by Setodji et al, there was inconclusive evidence that education affected treatment. 50…”