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

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American journal of kidney diseases : the official journal of the National Kidney Foundation


washington; spokane; pmrc


RATIONALE & OBJECTIVE: The effects of race, ethnicity, socioeconomic status, and disease severity on acute care utilization (ACU) in patients with glomerular disease (GD) are unknown.

STUDY DESIGN: A prospective cohort study.

SETTING: & Participants: 1,456 adults and 768 children with biopsy proven GD enrolled in the Cure Glomerulonephropathy cohort.

EXPOSURE: Race and ethnicity as a participant-reported social factor.

OUTCOME: ACU defined as hospitalizations or emergency department visits.

ANALYTICAL APPROACH: Multivariable recurrent event proportional rate models were used to estimate associations between race and ethnicity and ACU.

RESULTS: Black or Hispanic participants had lower socioeconomic status and more severe GD compared to White or Asian participants. ACU 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 to White race (reference group): Black race was significantly associated with ACU in adults (rate ratio (RR) 1.76, 95% Confidence Interval (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 ACU in children; Asian race was significantly associated with lower ACU in children (RR 0.32, 95% CI 0.14-0.70); no significant associations between Hispanic ethnicity and ACU were identified.

LIMITATIONS: We used proxies for socioeconomic status and lacked direct information on income, household unemployment or disability.

CONCLUSIONS: Significant differences in ACU rates were observed across racial and ethnic groups in persons with prevalent GD, although many of these difference were explained by differences in socioeconomic status and disease severity. Measures to combat socioeconomic disadvantage in Black patients, and more effectively prevent and treat glomerular disease, are needed to reduce disparities in ACU, improve patient wellbeing, and reduce healthcare costs.

Clinical Institute

Kidney & Diabetes