Abstract: FR-PO872

Impact of Social Capital and Other Environmental Factors on Hemodialysis Patients’ Health Outcomes

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Reviriego-Mendoza, Marta, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Larkin, John W., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Maddux, Dugan, Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Usvyat, Len A., Fresenius Medical Care North America, Waltham, Massachusetts, United States
  • Maddux, Franklin W., Fresenius Medical Care North America, Waltham, Massachusetts, United States
Background

While it is documented that environmental and societal factors impact general population’s health outcomes, most focus of dialysis research is on traditional biomarkers. Social capital, which has been defined as “connections among individuals – social networks and the norms of reciprocity and trustworthiness that arise from them” (Putnam, 2000), has been shown to significantly affect patient’s health (Kawachi et al., 1997; Yang et al., 2011). We thus aimed to investigate if social capital and other social determinants such as rurality and income have an effect on dialysis patients’ hospitalization rates.

Methods

We included all patients who initiated dialysis treatment in the Fresenius Kidney Care clinics from Jan-2013 to Dec-2016. Patient’s data was collected during the first 120 days on dialysis and included laboratory values and demographic data. Household income, educational level and rurality data was extracted from the United States Census Bureau at the zip code level. Data of county level measure of social capital was obtained from Rupasingha, et al., 2006. We calculated the impact of these variables on patients’ hospital admissions for the reminder of the first year on dialysis using Poisson model with log of exposure days as offset variable.

Results

A total of 49,195 patients were included in the study. From the analysis, it was estimated that both household income (beta=-0.001, p=0.1052) and education (beta=0.0000, p=0.8255) had only a small, non-significant impact on patients’ hospitalization rates. We also observed that patients who are married (-0.05, p less than 0.0001), living in a rural setting (-0.062, p=0.0017) and, to a lesser extent, in areas with more social capital (-0.020, p=0.1558), have a favorable impact on hospital admissions.

Conclusion

Rural settings and the existence of social networks may encourage neighbors’ awareness. Our analysis suggests that, in addition to the health status and access of care, dialysis patients’ clinical outcomes may be affected by their environmental and social surroundings. Deeper analyses are warranted to better understand the effects of social determinants on patients, outcomes.

Funding

  • Commercial Support