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Kidney Week

Abstract: SA-PO036

Social Deprivation Index and Kidney Failure Replacement Therapy (KFRT) Risk Among 2.5 Million Patients

Session Information

Category: Diversity and Equity in Kidney Health

  • 900 Diversity and Equity in Kidney Health

Authors

  • Crews, Deidra C., Johns Hopkins Medicine, Baltimore, Maryland, United States
  • Sang, Yingying, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
  • Grams, Morgan, New York University, New York, New York, United States
  • Ballew, Shoshana, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
  • Ndumele, Chiadi E., Johns Hopkins Medicine, Baltimore, Maryland, United States
  • Matsushita, Kunihiro, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
  • Coresh, Josef, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States
Background

Neighborhood-level social determinants of health (SDOH) are known to influence kidney disease risk. However, limited SDOH data are available from large, multi-ethnic, national samples with measured risk factors. We aimed to determine the extent to which place-based measures of SDOH relate to KFRT risk, and whether the associations vary by race/ethnicity.

Methods

We studied 2,536,627 patients in the Optum Labs Data Warehouse. Social deprivation index (SDI, deciles 1 to 10 as a composite measure of poverty, education, employment, home rental & crowding, single-parent households and no car ownership, with 10 representing the most deprived status) was geocoded at the zip code level. Cox models quantified the adjusted relative hazard of incident KFRT defined using hospitalization billing codes overall, and stratified by race/ethnicity (as coded in the electronic health record).

Results

Patients were a mean age of 52 years, 57% were female, 9.8% were Black and 4.3% were Hispanic persons; most were insured (76% commercial, 16% Medicare, 2.6% Medicaid, 2.4% uninsured and 0.8% other type). Median SDI differed by race/ethnicity, with Black and Hispanic patients having markedly higher social deprivation. SDI was associated with risk of KFRT in all models overall and across race/ethnicity groups.

Conclusion

Social deprivation is consistently associated with KFRT risk even after adjustment for established risk factors. The unequal distribution of SDI by race/ethnicity likely reflects both present and past influences, including structural racism.

Funding

  • NIDDK Support