Abstract: TH-PO811

Impact of Employment Status or Insurance Type on Outcomes Among Patients with ESRD

Session Information

Category: Dialysis

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

Authors

  • Luo, Jiacong, DaVita Clinical Research, Minneapolis, Minnesota, United States
  • Cohen, Dena E., DaVita Clinical Research, Minneapolis, Minnesota, United States
  • Brunelli, Steven M., DaVita Clinical Research, Minneapolis, Minnesota, United States
Background

It is widely thought that patients with end-stage renal disease who remain employed and/or commercially insured following dialysis initiation have better clinical outcomes and higher quality of life than those who do not. However, scientifically robust data are lacking.

Methods

This retrospective (2015-2016) study considered incident patients at a large US dialysis organization. Exposures of interest were insurance status (commercial, N=4858; Medicare/self-pay, N=13,329) and employment status (employed, N=1848; unemployed, N=10,001). Clinical outcomes and Kidney Disease Quality of Life (KDQoL) scores were determined from electronic health records. Comparisons were made using intention-to-treat principles and generalized linear models adjusted for imbalanced patient characteristics, including sociodemographic variables.

Results

Compared to commercial insurance, Medicare/self-pay was independently associated with higher rates of mortality and hospitalization, lower rates of transplant, and lower KDQoL scores in 4 of 5 domains. Similarly, unemployment (vs. employment) was independently associated with higher rates of mortality and hospitalization, lower rates of transplant, and lower KDQoL scores in 4 of 5 domains. Among patients who initiated dialysis while unemployed, those who resumed work by dialysis day 180 had lower rates of hospitalization (adjusted rate ratio 0.46, 95% confidence interval 0.25-0.84) than those who remained unemployed.

Conclusion

Commercial insurance, and separately, employment, were independently associated with better clinical and quality of life outcomes compared to other insurance and employment categories. These findings may inform patient and physician education, and guide advocacy efforts.

Funding

  • Commercial Support