Abstract: SA-PO0356
Does a Collective Socioeconomic and Community Factor Affect the Association Between Race and End-of-Life Care in Dialysis?
Session Information
- Dialysis: Epidemiology and Facility Management
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Noorani, Naziya, Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia, United States
- Paul, Sudeshna, Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia, United States
- Plantinga, Laura, University of California San Francisco, San Francisco, California, United States
- Song, Mi-Kyung, Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia, United States
Background
Non-White adults on dialysis are more likely to receive intensive end-of-life (EOL) treatment than White adults. Recent studies suggest that individual community factors (e.g., poverty, lack of access to transportation) may influence the relationship between race and EOL care. The Social Vulnerability Index (SVI) is an aggregate measure of socioeconomic and community-level factors that make individuals and communities susceptible to the negative impacts of hazards. We examined whether SVI modifies the relationship between race and EOL treatment.
Methods
Using USRDS data of adults on maintenance dialysis who died between 2010 and 2020 (149,769 decedents), we examined EOL treatment (e.g., ICU admissions, intubation, hospice) during the last month of life. Residential county-level SVI scores (range=0-1; higher SVI=higher vulnerability) were categorized into tertiles (low, moderate, and high). We examined whether the associations between race and EOL care differed by SVI using logistic regression models with an interaction term (race x SVI).
Results
Non-White decedents (n=44,955) were nearly 3 times more likely to live in high SVI areas compared to White decedents (OR: 2.95; 95% CI: 2.88-3.01) and, overall, had 16% higher odds of an ICU admission and 20% lower odds of receiving hospice care in the last month of life. There was no difference by race in the odds of hospitalization or receiving dialysis in the last month of life. Across SVI tertiles, The estimates of racial differences in EOL treatment were similar (Table 1).
Conclusion
The findings suggest that social vulnerability may not modify the association between race and EOL care intensity.
Table 1. Associations between race and EOL care by SVI tertile
| OR comparing non-White to White (95% CI) for: | |||
| ICU Admission | Intubation | Hospice | |
| Overall | 1.16 (1.13-1.18) | 1.59 (1.53-1.65) | 0.80 (0.78-0.81) |
| Stratified estimates within SVI tertile | |||
| Low (0.00-0.41) | 1.15 (1.10-1.21) | 1.64 (1.50-1.79) | 0.73 (0.69-0.76) |
| Moderate (0.41-0.67) | 1.06 (1.02-1.10) | 1.40 (1.30-1.50) | 0.79 (0.76-0.82) |
| High (0.67-1.00) | 1.15 (1.11-1.20) | 1.55 (1.45-1.65) | 0.78 (0.75-0.81) |
| p-value for Race x SVI | 0.005 | 0.005 | 0.019 |
ORs adjusted for age at death, sex, last dialysis modality, previous transplant recipient, and number of comorbid conditions
Funding
- Other NIH Support