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Abstract: SA-OR41

Racial-Ethnic and Socioeconomic Disparities in Healthcare Utilization Among Children with Glomerular Disease in the CureGN Project

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Krissberg, Jill, Stanford University School of Medicine, Stanford, California, United States
  • Helmuth, Margaret, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • O'Shaughnessy, Michelle M., Cork University Hospital Group, Cork, Ireland

Group or Team Name

  • for CureGN
Background

Inpatient charges for nephrotic syndrome differ across racial-ethnic groups. This study compares rates of ACU (acute care utilization i.e., hospitalization or ED visit) across racial-ethnic groups in children with glomerular disease (GD) and explores demographic, socioeconomic (SE), and disease-related factors that might explain any observed differences.

Methods

CureGN is a multinational prospective cohort study of prevalent patients with GD. We compared patient and disease characteristics at enrollment and rates of ACU during follow-up across racial-ethnic groups. We used multivariable recurrent event proportional rate models to determine rate ratios of ACU, serially adjusting for potential confounders.

Results

In 785 children with GD (median age 11.3 yrs, 58% male, 66% White, 88% residing in US, 51% privately insured, median urine protein/creatinine 0.4g/g, 34% with edema, 39% receiving steroids, 48% receiving other immunosuppression), with a median follow-up of 2.4 yrs, the ACU rate was significantly higher in Black, lower in Asian, and similar in Hispanic, vs. White children (0.85, 0.22, 0.55, and 0.56 events per patient yr, respectively, p<0.001). After multivariable adjustment, poorer SE status and more severe disease explained the excess events observed in Black Children, while an independent association between Asian race-ethnicity and lower rate of ACU was maintained (adjusted RR 0.42, 95% CI 0.25 - 0.72), Table.

Conclusion

The higher rate of ACU observed in Black children with GD enrolled in CureGN was largely explained by poorer SES and more severe disease. Strategies to prevent socioeconomic consequences of GD, or more effectively treat GD, among Black children with GD might begin to target ACU disparities.