Impact of poverty and race on pre-end-stage renal disease care among dialysis patients in the United States
Impact of poverty and race on pre-end-stage renal disease care among dialysis patients in the United States
复制标题
DOI：
10.1093/ckj/sfw098
复制
发表时间：
2017-02-01
影响因子：
4.6
通讯作者：
Abbott, Kevin C.
中科院分区：
文献类型：
--
作者：
Nee, Robert;Yuan, Christina M.;Abbott, Kevin C.
背景：在终末期肾脏疾病（ESRD）之前获得肾脏学护理与较低的发病率和死亡率显著相关。我们评估了地区水平和个人水平的贫困和种族/民族指标与肾内科医生提供的esrd前护理的关系。方法：在这项使用美国肾脏数据系统数据库的回顾性队列研究中，我们确定了从2007年1月1日至2012年12月31日开始进行维持性透析的739537例患者。我们评估了医疗保险-医疗补助双重资格状况，将其作为个人贫困水平和邮政编码水平家庭收入中位数（MHI）数据的指标，这些数据来自2010年美国人口普查。我们将esrd前肾病护理作为结果变量进行多变量logistic回归。结果：在最低区域水平MHI的患者中，61.28%的患者接受了esrd前肾病护理，而在高五分位数的患者中，这一比例为67.68% （P < 0.001）。同样，双重条件和非双重条件患者接受esrd前肾病护理的比例分别为61.49%和69.84% （P < 0.001）。与高五分位数的患者相比，最低区域水平MHI的患者接受esrd前肾病护理的可能性显著降低（调整优势比[aOR] 0.86[95%可信区间（CI） 0.85-0.87]）。非裔美国人（AA）和西班牙裔患者接受esrd前肾病护理的可能性均显著降低[aOR分别为0.85 （95% CI 0.84-0.86）和0.72 (95% CI 0.71-0.74)]。结论：个人和地区层面的贫困、AA种族和西班牙裔种族与esrd前肾病护理的可能性较低独立相关。努力改善esrd前肾病护理可能需要关注穷人和少数群体。
Background: Access to nephrology care prior to end-stage renal disease (ESRD) is significantly associated with lower rates of morbidity and mortality. We assessed the association of area-level and individual-level indicators of poverty and race/ethnicity on pre-ESRD care provided by nephrologists.Methods: In this retrospective cohort study using the US Renal Data System database, we identified 739 537 patients initiated on maintenance dialysis from 1 January 2007 through 31 December 2012. We assessed the Medicare-Medicaid dual eligibility status as an indicator of individual-level poverty and ZIP code-level median household income (MHI) data obtained from the 2010 US census. We conducted multivariable logistic regression of pre-ESRD nephrology care as the outcome variable.Results: Among patients in the lowest area-level MHI quintile, 61.28% received pre-ESRD nephrology care versus 67.68% among those in higher quintiles (P < 0.001). Similarly, the proportions of dual-eligible and nondual-eligible patients who had pre-ESRD nephrology care were 61.49 and 69.84%, respectively (P < 0.001). Patients in the lowest area-level MHI quintile were associated with significantly lower likelihood of pre-ESRD nephrology care (adjusted odds ratio [aOR] 0.86 [95% confidence interval (CI) 0.85-0.87]) compared with those in higher quintiles. Both African American (AA) and Hispanic patients were significantly less likely to have received pre-ESRD nephrology care [aOR 0.85 (95% CI 0.84-0.86) and aOR 0.72 (95% CI 0.71-0.74), respectively].Conclusions: Individual-and area-level measures of poverty, AA race and Hispanic ethnicity were independently associated with a lower likelihood of pre-ESRD nephrology care. Efforts to improve pre-ESRD nephrology care may require focusing on the poor and minority groups.