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Kidney Week

Abstract: PO1252

Social Determinants of Health (SDOH) and Healthcare Resource Utilization (HRU) in Autosomal Dominant Polycystic Kidney Disease (ADPKD) by CKD Stage

Session Information

Category: Genetic Diseases of the Kidneys

  • 1001 Genetic Diseases of the Kidneys: Cystic

Authors

  • Kilgore, Karl M., Avalere Health, Washington, District of Columbia, United States
  • Mohammadi, Iman, Avalere Health, Washington, District of Columbia, United States
  • Japes, Hina, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, United States
  • Frank, Laura Lewis, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, United States
  • Aijaz, Tazin R., Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, United States
  • Teigland, Christie, Avalere Health, Washington, District of Columbia, United States
  • Pareja, Kristin, Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, New Jersey, United States
Background

SDOH contribute to health disparities in CKD. This study describes SDOH and HRU in ADPKD patients with commercial (COM) insurance compared to a lower income managed Medicaid (MM) population.

Methods

The study included 8,766 COM and 5,416 MM patients from a national claims database. Patients had ≥2 ADPKD diagnoses between 7/1/2016- 12/31/2018 and were continuously enrolled for minimum 12 months. Patients were linked to SDOH by 9-digit ZIP address providing a precise assignment compared to Census data. HRU included inpatient days and emergency room (ER) visits per 1000 patients per month (PPPM) over 1-year follow-up.

Results

MM patients were more likely to be female (60% vs 54% COM) and on average 8 years younger. MM patients had 1.3x higher Charlson Comorbidity Index (CCI) scores, 40% lower income, were 2x more likely to live below federal poverty level, 1.3x less likely to complete high school, 2.7x more likely to speak English not well or at all, 2.6x less likely to own a vehicle, 53% more likely to be unemployed, and lived in a primary/mental health care shortage area 6.8%/6.4% more often.

The differences between payers were consistent across CKD stages, except CCI scores increased with higher CKD stage for both groups. Disparities in income, unemployment rates and provider shortages tended to increase with CKD stage.

Mean bed days ranged from 34.6 (Stage 1) to 402 (ESRD) PPPM for COM patients and were 3-4x higher overall in MM, ranging from 112 to 874 across CKD stages. Similarly, ER visits PPPM ranged from 38 to 114 for COM and 154 to 376 for MM. Hospital readmissions and use of post-acute care were high in both groups, with 15% of COM and 20% of MM readmitted within 30-days of inpatient stay and 2.8%-15.2% COM and 3.5%-25.8% MM having at least one PAC stay during follow-up. HRU increased with CKD stage.

Conclusion

ADPKD patients have large variation in SDOH by type of insurance. Lower social status of MM patients may be associated with higher HRU, and these disparities appear to increase as CKD stage progresses. In the clinical care of this vulnerable population, consideration of SDOH such as language barriers, transportation insecurity, and poverty is recommended.

Funding

  • Commercial Support