ASN's Mission

ASN leads the fight to prevent, treat, and cure kidney diseases throughout the world by educating health professionals and scientists, advancing research and innovation, communicating new knowledge, and advocating for the highest quality care for patients.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: FR-OR23

Associations of Local Area Deprivation Index with Outcomes During the First Year of Maintenance Dialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Weinhandl, Eric D., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Gilbertson, David T., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Wetmore, James B., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
  • Johansen, Kirsten L., Hennepin Healthcare Research Institute, Minneapolis, Minnesota, United States
Background

Clinical outcomes among patients undergoing maintenance dialysis are typically ascribed to non-modifiable patient characteristics and treatments. However, outcomes may be highly influenced by local socioeconomic conditions. We assessed whether the Area Deprivation Index (ADI), a composite measure of income, education, employment, and housing quality within 9-digit ZIP Code areas, is associated with the incidence of death and kidney transplantation during the first year of maintenance dialysis.

Methods

We analyzed United States Renal Data System Standard Analysis Files. The cohort included patients who initiated outpatient dialysis in 2014-2017; we retained patients with a 9-digit ZIP Code of residence, according to the Medicare Enrollment Database, as that code facilitated linkage to the ADI. Patients were followed from the initiation of outpatient dialysis to the earlier of death or kidney transplantation; patients were censored after one year of follow-up. We fit Cox models of death and kidney transplantation, including ADI decile (higher = more disadvantaged) and adjustment for age, sex, race/ethnicity, primary cause of end stage kidney disease, comorbidity, and dialysis modality.

Results

The cohort included 381,623 patients. Over 14% of patients resided in 9-digit ZIP Codes in the highest ADI decile. ADI deciles were linearly associated with adjusted hazards of death and kidney transplantation (table). The highest versus lowest ADI decile was associated with 20% higher rate of death and 72% lower rate of transplantation.

Conclusion

Increasing socioeconomic disadvantage in the local area was associated with higher rates of death and markedly lower rates of transplantation during the first year of dialysis.

 AHR of deathAHR of kidney transplant
ADI decile 11.00 (referent)1.00 (referent)
ADI decile 21.01 (0.97-1.05)0.83 (0.75-0.93)
ADI decile 31.04 (1.00-1.08)0.77 (0.69-0.85)
ADI decile 41.06 (1.02-1.10)0.73 (0.66-0.81)
ADI decile 51.09 (1.05-1.13)0.70 (0.63-0.78)
ADI decile 61.10 (1.06-1.15)0.57 (0.51-0.63)
ADI decile 71.12 (1.08-1.16)0.50 (0.44-0.56)
ADI decile 81.14 (1.09-1.18)0.42 (0.37-0.47)
ADI decile 91.18 (1.14-1.23)0.38 (0.34-0.43)
ADI decile 101.20 (1.16-1.25)0.28 (0.25-0.32)

Abbreviations: ADI, area deprivation index; AHR, adjusted hazard ratio.

Funding

  • NIDDK Support