Trends in Chronic Kidney Disease Care in the US by Race and Ethnicity, 2012-2019.
Trends in Chronic Kidney Disease Care in the US by Race and Ethnicity, 2012-2019.
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DOI：
10.1001/jamanetworkopen.2021.27014
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发表时间：
2021-09-01
影响因子：
13.8
通讯作者：
Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team
中科院分区：
文献类型：
--
作者：
Chu CD;Powe NR;McCulloch CE;Crews DC;Han Y;Bragg-Gresham JL;Saran R;Koyama A;Burrows NR;Tuot DS;Centers for Disease Control and Prevention Chronic Kidney Disease Surveillance Team
指南推荐的慢性肾脏疾病（CKD）护理是否因种族和民族而有差异？在这项横断面研究中，2012年至2019年期间，452238名商业保险和医疗保险优惠的美国CKD成人患者与白人患者相比，亚裔、黑人和西班牙裔患者在许多护理措施（例如，他汀类药物使用和肾素-血管紧张素阻断）方面的表现更高，但在血压和糖尿病控制方面的表现相似或更差。亚裔、黑人和西班牙裔患者在多种CKD护理措施上的更高表现表明，护理服务的差异不太可能完全解释CKD进展和肾衰竭的已知差异。慢性肾脏疾病（CKD）进展和结果的显著种族和民族差异已被充分记录，指南推荐的CKD治疗使用率也很低。在一个大的、多样化的人群中，按种族和民族检查指南推荐的CKD护理服务。在这项连续横断面研究中，在2012年1月1日至2019年12月31日的2年横断面中确定了不需要透析的成年CKD患者，定义为肾小球滤过率持续估计小于60 mL/min/1.73 m2或尿白蛋白-肌酐比大于或等于30 mg/g至少90天。数据来自OptumLabs数据仓库，这是商业保险和医疗保险优惠患者的行政和电子健康记录数据的国家数据集。独立变量是种族和民族，如相关电子健康记录中报告的那样。在指南推荐的CKD护理的基础上，该研究检查了护理过程措施（白蛋白尿的血管紧张素转换酶抑制剂或血管紧张素II受体阻滞剂处方，他汀类药物处方，白蛋白尿检测，CKD 4期或以上的肾病学护理，以及避免慢性非甾体抗炎药处方）和护理结果措施（血压和糖尿病控制）。共有452 238例患者符合纳入标准（平均[SD]年龄74.0[10.2]岁；女性262 089例[58.0%]；亚裔7573例[1.7%]，黑人49 970例[11.0%]，西班牙裔15 540例[3.4%]，白人379 155例[83.8%]）。在血管紧张素转换酶抑制剂和血管紧张素II受体阻滞剂的使用方面，亚裔、黑人和西班牙裔患者的过程测量表现高于白人患者（2018-2019年，亚裔患者为79.8%，黑人患者为76.7%，西班牙裔患者为79.9%，白人患者为72.3%），他汀类药物的使用（亚洲患者为72.6%，黑人患者为69.1%，西班牙裔患者为74.1%，白人患者为61.5%）。肾病学护理（亚洲患者为64.8%，黑人患者为72.9%，西班牙裔患者为69.4%，白人患者为58.3%）和蛋白尿检测（亚洲患者为53.9%，黑人患者为41.0%，西班牙裔患者为52.6%，白人患者为30.7%）。与白人患者（72.9%）相比，亚裔（71.8%）、黑人（63.3%）和西班牙裔（69.8%）患者将血压控制在140/90 mm Hg以下的情况相似或更低。在糖化血红蛋白A1c低于7.0%的情况下，亚洲患者的糖尿病控制成功率为50.1%，黑人患者为49.3%，西班牙裔患者为46.0%，而白人患者为50.3%。亚裔、黑人和西班牙裔患者在CKD护理过程测量中的较高表现表明，药物处方和诊断测试的差异不太可能完全解释CKD进展和肾衰竭的已知差异。仅仅改善护理提供过程可能不足以缩小这些差距。本横断面研究评估了美国大量慢性肾脏疾病成人患者中按种族和民族划分的慢性肾脏疾病护理提供趋势。
Are there differences in guideline-recommended care delivery for chronic kidney disease (CKD) by race and ethnicity? In this cross-sectional study of 452 238 commercially insured and Medicare Advantage US adults with CKD from 2012 to 2019, compared with White patients, Asian, Black, and Hispanic patients had higher performance across many care delivery measures (eg, statin use and renin-angiotensin blockade) but similar or poorer performance on blood pressure and diabetes control. Higher performance on multiple CKD care measures among Asian, Black, and Hispanic patients suggests that differences in care delivery are unlikely to fully explain known disparities in CKD progression and kidney failure. Significant racial and ethnic disparities in chronic kidney disease (CKD) progression and outcomes are well documented, as is low use of guideline-recommended CKD care. To examine guideline-recommended CKD care delivery by race and ethnicity in a large, diverse population. In this serial cross-sectional study, adult patients with CKD that did not require dialysis, defined as a persistent estimated glomerular filtration rate less than 60 mL/min/1.73 m2 or a urine albumin-creatinine ratio of 30 mg/g or higher for at least 90 days, were identified in 2-year cross-sections from January 1, 2012, to December 31, 2019. Data from the OptumLabs Data Warehouse, a national data set of administrative and electronic health record data for commercially insured and Medicare Advantage patients, were used. The independent variables were race and ethnicity, as reported in linked electronic health records. On the basis of guideline-recommended CKD care, the study examined care delivery process measures (angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker prescription for albuminuria, statin prescription, albuminuria testing, nephrology care for CKD stage 4 or higher, and avoidance of chronic nonsteroidal anti-inflammatory drug prescription) and care delivery outcome measures (blood pressure and diabetes control). A total of 452 238 patients met the inclusion criteria (mean [SD] age, 74.0 [10.2] years; 262 089 [58.0%] female; a total of 7573 [1.7%] Asian, 49 970 [11.0%] Black, 15 540 [3.4%] Hispanic, and 379 155 [83.8%] White). Performance on process measures was higher among Asian, Black, and Hispanic patients compared with White patients for angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker use (79.8% for Asian patients, 76.7% for Black patients, and 79.9% for Hispanic patients compared with 72.3% for White patients in 2018-2019), statin use (72.6% for Asian patients, 69.1% for Black patients, and 74.1% for Hispanic patients compared with 61.5% for White patients), nephrology care (64.8% for Asian patients, 72.9% for Black patients, and 69.4% for Hispanic patients compared with 58.3% for White patients), and albuminuria testing (53.9% for Asian patients, 41.0% for Black patients, and 52.6% for Hispanic patients compared with 30.7% for White patients). Achievement of blood pressure control to less than 140/90 mm Hg was similar or lower among Asian (71.8%), Black (63.3%), and Hispanic (69.8%) patients compared with White patients (72.9%). Achievement of diabetes control with hemoglobin A1c less than 7.0% was 50.1% in Asian patients, 49.3% in Black patients, and 46.0% in Hispanic patients compared with 50.3% for White patients. Higher performance on CKD care process measures among Asian, Black, and Hispanic patients suggests that differences in medication prescription and diagnostic testing are unlikely to fully explain known disparities in CKD progression and kidney failure. Improving care delivery processes alone may be inadequate for reducing these disparities. This cross-sectional study evaluates trends in chronic kidney disease care delivery by race and ethnicity in a large population of US adults with chronic kidney disease.
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影响因子：
3.3
作者：
Nicholas, Susanne B.;Kalantar-Zadeh, Kamyar;Norris, Keith C.
通讯作者：
Norris, Keith C.
影响因子：
158.5
作者：
Perkovic, V.;Jardine, M. J.;Bentley-Lewis, Rhonda
通讯作者：
Bentley-Lewis, Rhonda
DOI：
10.1053/j.ajkd.2016.05.030
发表时间：
2016-12
期刊：
American journal of kidney diseases : the official journal of the National Kidney Foundation
影响因子：
--
作者：
Albertus P;Morgenstern H;Robinson B;Saran R
通讯作者：
Saran R
影响因子：
13.8
作者：
Eberly LA;Yang L;Eneanya ND;Essien U;Julien H;Nathan AS;Khatana SAM;Dayoub EJ;Fanaroff AC;Giri J;Groeneveld PW;Adusumalli S
通讯作者：
Adusumalli S
影响因子：
5.4
作者：
Mefford, Matthew T.;Rosenson, Robert S.;Muntner, Paul
通讯作者：
Muntner, Paul