Abstract: TH-PO722
A Demographic and Community Characteristic Comparison of Advanced CKD Patients Seeing vs. Not Seeing a Nephrologist
Session Information
- Diversity and Equity in Kidney Health - I
November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Diversity and Equity in Kidney Health
- 800 Diversity and Equity in Kidney Health
Authors
- Devaraj, Susan M., University of Pittsburgh Department of Medicine, Pittsburgh, Pennsylvania, United States
- Yabes, Jonathan, University of Pittsburgh Department of Medicine, Pittsburgh, Pennsylvania, United States
- Cai, Manqi, University of Pittsburgh Department of Medicine, Pittsburgh, Pennsylvania, United States
- Lavenburg, Linda-Marie Ustaris, University of Pennsylvania Department of Medicine, Philadelphia, Pennsylvania, United States
- Abdel-Kader, Khaled, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Jhamb, Manisha, University of Pittsburgh Department of Medicine, Pittsburgh, Pennsylvania, United States
Background
Despite the health benefits of receiving specialized care from a nephrologist, the majority of chronic kidney disease (CKD) patients are managed by primary care providers (PCPs). We explored potential individual and neighborhood level demographic differences among patients with high-risk CKD seeing versus not seeing a nephrologist.
Methods
Adult patients (age >18 years) in Western PA with advanced CKD (eGFR<30) who were managed by a PCP and not seeing a nephrologist were identified from an ongoing population health management study called Kidney CHAMP (enrolled years 2018-22). Their baseline characteristics were compared to a cohort of patients seeing a nephrologist at the kidney clinic at an academic center in Western PA between 2010-2012. Differences in individual patient (age, race, gender) and zip-code level characteristics [Social Deprivation Index (SDI) and Rural Urban Commuting Area] between those seeing vs not seeing a nephrologist were compared using chi-square and t-tests. Multivariable logistic regression models including patient demographics and serum creatinine were used to determine the odds of having seen a nephrologist. Additional analyses are planned to explore other drivers of care.
Results
A total of 1,594 patients were not seeing a nephrologist, and 577 were seeing a nephrologist. Compared to patients seeing a nephrologist, patients not seeing a nephrologist were older (age 74 vs. 67 years, p<0.01), more likely to be women (58% vs. 49%, p<0.01), white (91% vs. 75%, p<0.01), were living in rural areas (11% vs. 2%, p<0.01), and had lower SDI scores meaning less social deprivation (score 40 vs. 43, p=0.01). Multivariable models showed a significantly lower odds of seeing a nephrologist with each year of age (OR: 0.97, p<0.01), white vs. black race (OR: 0.56, p<0.01), micropolitan vs metropolitan (OR: 0.37, p<0.01), and rural vs. metropolitan home address (OR: 0.13, p<0.01), and higher odds with each unit increase in creatinine (OR: 3.18, p<0.01).
Conclusion
Older age, white race, and living in a non-metropolitan area were independently associated with less engagement in nephrology care. Understanding factors associated with receiving specialty care may help to inform interventions to improve access for those most in need.
Funding
- NIDDK Support