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Racial and Ethnic Disparities in Acute Care Utilization Among Patients With Glomerular Disease.

Authors :
Krissberg JR
O'Shaughnessy MM
Smith AR
Helmuth ME
Almaani S
Aviles DH
Brathwaite KE
Cai Y
Cattran D
Gbadegesin R
Glenn DA
Greenbaum LA
Iragorri S
Jain K
Khalid M
Kidd J
Kopp J
Lafayette R
Lane JC
Lugani F
Nestor JG
Parekh RS
Reidy K
Selewski DT
Sethna CB
Sperati CJ
Tuttle K
Twombley K
Vasylyeva TL
Weaver DJ Jr
Wenderfer SE
Gibson K
Source :
American journal of kidney diseases : the official journal of the National Kidney Foundation [Am J Kidney Dis] 2023 Mar; Vol. 81 (3), pp. 318-328.e1. Date of Electronic Publication: 2022 Oct 01.
Publication Year :
2023

Abstract

Rationale & Objective: The effects of race, ethnicity, socioeconomic status (SES), and disease severity on acute care utilization in patients with glomerular disease are unknown.<br />Study Design: Prospective cohort study.<br />Setting & Participants: 1,456 adults and 768 children with biopsy-proven glomerular disease enrolled in the Cure Glomerulonephropathy (CureGN) cohort.<br />Exposure: Race and ethnicity as a participant-reported social factor.<br />Outcome: Acute care utilization defined as hospitalizations or emergency department visits.<br />Analytical Approach: Multivariable recurrent event proportional rate models were used to estimate associations between race and ethnicity and acute care utilization.<br />Results: Black or Hispanic participants had lower SES and more severe glomerular disease than White or Asian participants. Acute care utilization rates were 45.6, 29.5, 25.8, and 19.2 per 100 person-years in Black, Hispanic, White, and Asian adults, respectively, and 55.8, 42.5, 40.8, and 13.0, respectively, for children. Compared with the White race (reference group), Black race was significantly associated with acute care utilization in adults (rate ratio [RR], 1.76 [95% CI, 1.37-2.27]), although this finding was attenuated after multivariable adjustment (RR, 1.31 [95% CI, 1.03-1.68]). Black race was not significantly associated with acute care utilization in children; Asian race was significantly associated with lower acute care utilization in children (RR, 0.32 [95% CI 0.14-0.70]); no significant associations between Hispanic ethnicity and acute care utilization were identified.<br />Limitations: We used proxies for SES and lacked direct information on income, household unemployment, or disability.<br />Conclusions: Significant differences in acute care utilization rates were observed across racial and ethnic groups in persons with prevalent glomerular disease, although many of these difference were explained by differences in SES and disease severity. Measures to combat socioeconomic disadvantage in Black patients and to more effectively prevent and treat glomerular disease are needed to reduce disparities in acute care utilization, improve patient wellbeing, and reduce health care costs.<br /> (Copyright © 2022 National Kidney Foundation, Inc. All rights reserved.)

Details

Language :
English
ISSN :
1523-6838
Volume :
81
Issue :
3
Database :
MEDLINE
Journal :
American journal of kidney diseases : the official journal of the National Kidney Foundation
Publication Type :
Academic Journal
Accession number :
36191724
Full Text :
https://doi.org/10.1053/j.ajkd.2022.08.010