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Kidney Week

Abstract: SA-OR016

Reported Kidney Disease Awareness and Medical Subspecialty Use before and after the Affordable Care Act Implementation among National Health Interview Survey Participants

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 307 CKD: Health Services, Disparities, Prevention


  • Jovanovich, Anna Jeanette, Denver VA / University of Colorado, Denver, Colorado, United States
  • Chonchol, Michel, University of Colorado, Aurora, Colorado, United States
  • You, Zhiying, UC Denver, Aurora, Colorado, United States

In the U.S., individual awareness of chronic kidney disease (CKD) is low. Nephrology referral improves CKD awareness and clinical outcomes. The Affordable Care Act (ACA) implementation on January 1, 2014 increased insurance coverage and access to health care for people with chronic disease. It is unknown if the ACA has impacted people with CKD.


Utilizing National Health Interview Survey (NHIS) data, we compared kidney disease awareness and medical subspecialty use during 2012, a full year before the ACA implementation, and 2015, a full year after. The sample included 66,624 non-institutionalized U.S. citizens ages 19-64. In this quasi-experimental analysis, we used logistic regression to examine whether kidney disease awareness and medical subspecialty use increased after the ACA implementation, using weights as appropriate.


Baseline characteristics among NHIS participants in the years 2012 and 2015 were similar: age 47 years, 52% female, and 80% white. The percentage of participants reporting no health insurance coverage decreased from 17% in 2012 to 10% in 2012 (p <0.0001). Kidney disease awareness, medical subspecialty use, and a combination of both increased from 2012 to 2015: 1.6% to 2.0% (p = 0.002), 26% to 28% (p = 0.002), and 1.0% to 1.3% (p = 0.006), respectively. After adjustment for age, sex, race, ethnicity, marital status, education, income, and region, 2015 NHIS participants were 27% (odds ratio [OR] 1.27 [95% CI, 1.10-1.46]) more likely to report kidney disease awareness, 6% (OR 1.06, [95% CI, 1.00 to 1.11]) more likely to report medical subspecialty use, and 27% (OR 1.27 [95% CI, 1.07 to 1.50]) more likely to report both. When insurance status was added to the models, the magnitude of all the odds ratios was attenuated suggesting that insurance status influences reported kidney disease awareness and medical subspecialty use.


Kidney disease awareness and medical subspecialty use reported by NHIS participants significantly increased from 2012 to 2015, after the ACA implementation, while participants reporting no health insurance significantly decreased. These data suggest that the ACA improves access to care among people with CKD, and thus, may be key to improving clinical outcomes.


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