Abstract: SA-OR060
Urban Segregation and Hospitalization Outcomes in Patients on Hemodialysis
Session Information
- Hemodialysis Potpourri
November 09, 2019 | Location: 144, Walter E. Washington Convention Center
Abstract Time: 04:54 PM - 05:06 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Golestaneh, Ladan, Montefiore Medical Center, Bronx, New York, United States
- Cavanaugh, Kerri L., Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Karaboyas, Angelo, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
- Melamed, Michal L., Albert Einstein College of Medicine, New York, New York, United States
- Johns, Tanya S., Albert Einstein College of Medicine, New York, New York, United States
- Norris, Keith C., UCLA, Marina Del Rey, California, United States
Background
Patients receiving hemodialysis treatments in communities with a high percentage of Black residents have worse morbidity and mortality outcomes. To better understand drivers of this increased risk, we analyzed data from the United States cohort of the Dialysis Outcomes and Practice Patterns Study (US-DOPPS).
Methods
This analysis included 4567 patients on hemodialysis from 154 facilities in 127 zip codes from the US-DOPPS phases 4-5 (2010-2015) linked to American Community Survey (ACS) data. Negative binomial regression was used to test the association of community, defined by tertile of percent Black residents in dialysis facility zip code, with hospitalization rates, while adjusting for multiple confounders.
Results
The hospitalization incidence rate was 1.18 per year. Patients receiving dialysis in facility zip codes located in communities with a higher (tertile 3: ≥14.4%) vs. lower (tertile 1: ≤1.8%) percentage of Black residents were more likely to be younger, Black, live in urban areas, of lower socio-economic class, more likely to have a catheter as a vascular access, and had fewer comorbidities. These tertile 3 facilities were more likely for-profit and had higher patient counts, but did not differ with respect to clinical quality benchmarks or dialysis adherence. Compared to tertile 1, the covariate-adjusted IRR (95% CI) for hospitalization was 1.32 (1.13-1.55) for tertile 2 and 1.32 (1.14-1.54) for tertile 3 of percent Black residents. This association remained significant in multiple strata examined.
Conclusion
Patients receiving dialysis in communities with a high percentage of Black residents have higher adjusted hospitalization rates, despite having equivalent dialysis care benchmarks. Prospective studies to assess the role of social support, access to pre-ESRD and specialty service care, and patient engagement strategies from healthcare systems and nephrologists caring for these vulnerable populations are warranted.
Table 2: Incidence Rate Ratios (IRR) of Hospitalization Count with Tertile of Percent Black Residents in the Community
| Tertile of %Black residents (with dialysis facility zip code as nidus for ACS data Total n=4565 | Unadjusted IRR (95% CI) n-4565 | P for trend | Model 1: Adjusted IRR for Age & Sex (95% CI) (n=4565) | P for trend | Model 2: Adjusted IRR in with-out subject’s race data added (95% CI) (n=4565) | P for trend | Model 3: Adjusted IRR with patient race data added (95% CI) (n=4565) | P for trend |
| 1(range: 0-1.8%) 2(range: 1.9-11.3%) 3(range: 14.4-92.6%) | 1 1.11(0.96-1.30) 1.28(1.08-1.51) | 0.003 | 1 1.11(0.96-1.30) 1.29(1.09-1.52) | 0.003 | 1 1.18(0.99-1.40) 1.32(1.13-1.55) | 0.002 | 1 1.17(0.99-1.38) 1.32(1.14-1.54) | 0.001 |
CI: confidence interval
Funding
- Other NIH Support