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Kidney Week

Abstract: PO0472

Neighborhood Socioeconomic Status and Patterns of Kidney Care: Data from Electronic Health Records

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

Electronic health records (EHR) can be leveraged to assess quality of care measures in patients with CKD. Neighborhood socioeconomic status (SES) could be a potential barrier to receiving appropriate evidence-based therapy and follow up. Our goal was to examine whether neighborhood SES is independently associated with quality of care received by CKD patients.

Methods

EHR data for patients seen at a healthcare system in the 7-county Minneapolis/St Paul area and linked census tract data were used. Census tract SES measures used were: median value of owner occupied housing units (wealth), percentage of residents >25 years with ≥ Bachelor’s degree (education), and median household income (income). 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, respectively. CKD quality of care indicators used were: prescription for ACEi/ARB in patients with moderate to severe CKD or mild CKD+UACR >300 mg/day; UACR measurement; and CKD identified on the problem list or coded for at an encounter among patients with CKD (eGFR<60 ml/min/1.73 m2). We used a multilevel Poisson regression with robust error variance with a random intercept at the census tract level to estimate the association between each quality of CKD care measure and neighborhood SES.

Results

Of the 16,776 patients who should be on ACEi/ARB, 65% were prescribed these medications. In patients with CKD (n=25,097), UACR was measured in 27% of patients and only 55% of patients with CKD had CKD identified in their EHRs. Belonging to low neighborhood SES compared to high neighborhood SES was not associated with ACEi/ARB prescription compliance after adjusting for demographics and clinical characteristics (prevalence ratio (PR): wealth-0.96[0.91,1.03], education-1.01[0.97,1.05], income-0.97[0.94,1.02]). Neighborhood SES was not associated with UACR measurement after adjustment (PR: wealth-1.01[0.91,1.12], education-1.07[0.98,1.17], income-0.96[0.87,1.06]). Similarly, neighborhood SES was not associated with CKD identification in the EHR after adjustment (PR: wealth-1.02[0.98,1.06], education-1.03[0.98,1.07], income-1.01[0.97,1.06]).

Conclusion

Neighborhood SES is not associated with quality of CKD care received. However, adherence to CKD guidelines is low, indicating an opportunity to improve care for all patients, regardless of SES.