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Abstract: PO0473

Neighborhood Socioeconomic Status, Health Insurance, and CKD Prevalence: Findings from a Large Healthcare System

Session Information

Category: CKD (Non-Dialysis)

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

Authors

  • Ghazi, Lama, University of Minnesota, Minneapolis, Minnesota, United States
  • Drawz, Paul E., University of Minnesota, Minneapolis, Minnesota, United States
Background

The association of neighborhood characteristics and insurance status with chronic kidney disease (CKD) remain unclear. Therefore, we investigated the association of neighborhood socioeconomic (SES) and insurance type with CKD prevalence.

Methods

We utilized electronic health record (EHR) data of patients seen at a healthcare system in the 7-county metropolitan area in Minnesota and linked census tract data. Census tract measures [median value of owner occupied housing units (wealth), percentage of residents >25 years with ≥ Bachelor’s degree (education), and median household income (income)] and individual level insurance status (<65 years: Medicaid vs. other insurance; ≥65 years: Medicare vs. supplemental insurance plan) were obtained from the American Community Survey (2008-2012) and the EHR, respectively. A patient was considered to be living in low and high SES tracts if they belong to the first and fourth quartile of each SES measures. CKD prevalence was defined as having an estimated glomerular filtration rate (eGFR) <60/mL/min/1.73m2 or proteinuria. We used a multilevel Poisson regression with robust error variance with a random intercept at the census tract level to estimate the association between tract SES [low (first quartile) vs. high (fourth quartile)], insurance, and CKD.

Results

We included 185,269 patients. Tract SES (wealth and education) and insurance are independently associated with CKD prevalence. After adjusting for demographic and clinical characteristics, patients (<65 and ≥ 65 years) living in low vs. high SES tracts had higher CKD prevalence (Prevalence Ratio PR, 95%CI of low vs. high tract SES for education among patients <65 years: 1.11 [1.05, 1.18] and 1.08 [1.04, 1.12] for ≥65 years). Patients (<65 years) on Medicaid vs. other insurance had higher CKD prevalence (PR, 95%CI: 1.51 [1.43, 1.60]). For patients ≥65 years, insurance type was not associated with prevalence of CKD in the fully adjusted model.

Conclusion

In conclusion, we found that patients from low SES tracts and Medicaid recipients (among patients <65 years) have greater rates of CKD compared to patients from high SES tracts and patients with other insurance. These may be two of several socioeconomic and individual factors influencing the complexity of identification, management, and treatment of CKD.