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Kidney Week

Abstract: TH-PO398

State-Level Kidney Disease Surveillance Using Medicaid Data in Michigan and California

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Modi, Zubin J., University of Michigan, Ann Arbor, Michigan, United States
  • Li, Yiting, University of Michigan, Ann Arbor, Michigan, United States
  • Zhang, Xiaosong, University of Michigan, Ann Arbor, Michigan, United States
  • Tuot, Delphine S., University of California, San Francisco, San Francisco, California, United States
  • Pavkov, Meda E., Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Burrows, Nilka Rios, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
  • Powe, Neil R., University of California, San Francisco, San Francisco, California, United States
  • Gipson, Debbie S., University of Michigan, Ann Arbor, Michigan, United States
  • Saran, Rajiv, University of Michigan, Ann Arbor, Michigan, United States
Background

Medicaid provides health insurance for low-income individuals, including children. Coverage varies by state. We examined the feasibility of using state-level Medicaid data for chronic kidney disease (CKD) surveillance in a disadvantaged, low income, and younger US population.

Methods

The 2012 Medicaid Analytic eXtract data for the states of Michigan (MI) and California (CA) were evaluated. Patients with >3 months of Medicaid eligibility ≥1 claim were included. CKD was defined by two outpatient or one inpatient ICD-CM diagnosis codes. Descriptive analyses were conducted for children (age <22) and adults (age ≥ 22).

Results

The study population for MI (n=1,700,044) included 989,834 (58%) children and for CA (n=7,457,920) included 3,661,569 (49%) children. CKD was diagnosed in 0.9% of children (9,160) and 3.7% of adults (26,580) in MI, and 0.7% of children (24,090) and 3.0% of adults (114,183) in CA. There was geographic variation in prevalence of diagnosed CKD (Figure 1). Higher proportions of diabetes (DM) and hypertension (HTN) were seen in those with CKD (vs. non-CKD) in MI (DM: children 3.9% vs. 0.7%, adults 41.3% vs. 11.7%; HTN: children 7.6% vs 0.6%, adults 62.4% vs 17.2%) and CA (DM: children 2.2% vs. 0.4%, adults: 40.6% vs. 7.9%; HTN: children 6.6% vs. 0.2%, adults 47.7% vs. 11.1%). Emergency department use was higher among CKD patients (vs. non-CKD) in both MI (children 59.4% vs. 40.5%; adults 65.9% vs.40.9%) and CA (children 49.8% vs. 28.8%; adults 41.6% vs. 21.4%).

Conclusion

We demonstrate the feasibility of utilizing Medicaid data from two states for CKD surveillance efforts. There is substantial geographic variation of diagnosed CKD in both MI and CA with higher prevalence mostly in urban areas. Children and adults with CKD had a higher prevalence of comorbidities and ED use compared to those without CKD. This work serves as a foundation for future analyses of other state and longitudinal data to guide upstream disease prevention and management for a young and socioeconomically disadvantaged population.

Prevalence of Chronic Kidney Disease (per 1000 patients) in Michigan (A) and California (B), by county

Funding

  • Other U.S. Government Support