Patients on Dialysis Have More Hospitalizations in Areas With More Black Residents

Patients receiving dialysis living in communities with a high percentage of black residents are known to have worse morbidity and mortality outcomes, and a study presented Saturday at the American Society of Nephrology Kidney Week 2019 meeting found that patients receiving dialysis in those communities also had higher hospitalization rates.

Researchers analyzed data from the US cohort of the Dialysis Outcomes and Practice Patterns Study (US-DOPPS) to try to understand what causes the worse outcomes. The analysis included 4567 patients on hemodialysis from 154 facilities in 127 zip codes from the US-DOPPS phases 4-5 (2010-2015) linked to American Community Survey (ACS) data.

Dialysis facility zip code were divided into tertile of percent black residents. Patients receiving dialysis in facility zip codes located in communities with a higher (tertile 3: ≥14.4%) versus lower (tertile 1: ≤1.8%) percentage of black residents were more likely to be younger, black, live in urban areas, of a lower socioeconomic class, more likely to have a catheter as a vascular access, and have fewer comorbidities.

Patients receiving dialysis in communities with a high percentage of black residents had 32% higher hospitalization rates despite having equivalent dialysis care, according to Ladan Golestaneh, MD, MS. The association remained after adjusting for individual race, clinical comorbidities, community-level poverty, and dialysis quality and adherence.

While the tertile 3 facilities were more likely to be for-profit and had higher patient counts, they did not differ with respect to clinical quality benchmarks or dialysis adherence.

Golestaneh, of Albert Einstein College of Medicine/Montefiore Medical Center, said the difference “is likely not a result of differences in quality of dialysis care, adherence practices, or clinical factors, but rather a result of as yet unidentified community level determinants of health. Healthcare disparities continue to exist even after measures taken by Centers for Medicare and Medicaid services to bridge the quality gap, through measures such as the dialysis Quality Incentive Program, to promote high-quality services in outpatient dialysis facilities in communities across the US."

The other institutions involved in the study were the Arbor Research Collaborative for Health in Ann Arbor, Michigan, and Vanderbilt University Medical Center in Nashville, Tennessee.

The researchers recommended that future studies should examine the role of social support, access to care for pre—end-stage renal disease and specialty service care, as well as patient engagement strategies.

Reference

Golestaneh L, Cavanaugh KL, Karaboyas A, Melamed ML, Johns TS, Norris KC. Urban segregation and hospitalization outcomes in patients on hemodialysis. Presented at: American Society of Nephrology Kidney Week 2019, Washington, DC; November 5-10, 2019. Abstract OR060.