TY - JOUR
T1 - Racial and Ethnic Disparities in Acute Care Utilization Among Patients With Glomerular Disease
AU - CureGN Consortium
AU - Krissberg, Jill R.
AU - O'Shaughnessy, Michelle M.
AU - Smith, Abigail R.
AU - Helmuth, Margaret E.
AU - Almaani, Salem
AU - Aviles, Diego H.
AU - Brathwaite, Kaye E.
AU - Cai, Yi
AU - Cattran, Daniel
AU - Gbadegesin, Rasheed
AU - Glenn, Dorey A.
AU - Greenbaum, Larry A.
AU - Iragorri, Sandra
AU - Jain, Koyal
AU - Khalid, Myda
AU - Kidd, Jason
AU - Kopp, Jeffrey
AU - Lafayette, Richard
AU - Lane, Jerome C.
AU - Lugani, Francesca
AU - Nestor, Jordan G.
AU - Parekh, Rulan S.
AU - Reidy, Kimberly
AU - Selewski, David T.
AU - Sethna, Christine B.
AU - Sperati, C. John
AU - Tuttle, Katherine
AU - Twombley, Katherine
AU - Vasylyeva, Tetyana L.
AU - Weaver, Donald J.
AU - Wenderfer, Scott E.
AU - Gibson, Keisha
AU - Ahn, Wooin
AU - Appel, Gerald
AU - Appelbaum, Paul
AU - Babayev, Revekka
AU - Bomback, Andrew
AU - Brown, Eric
AU - Canetta, Pietro
AU - Carlassara, Lucrezia
AU - Chan, Brenda
AU - D'Agati, Vivette Denise
AU - Dogra, Samitri
AU - Fernandez, Hilda
AU - Gharavi, Ali
AU - Hines, William
AU - Husain, Syed Ali
AU - Kiryluk, Krzysztof
AU - Lin, Fangming
AU - Marasa, Maddalena
AU - Markowitz, Glen
AU - Rasouly, Hila Milo
AU - Mohan, Sumit
AU - Mongera, Nicola
AU - Nickolas, Thomas
AU - Radhakrishnan, Jai
AU - Rao, Maya
AU - Sanna-Cherchi, Simone
AU - Shirazian, Shayan
AU - Stokes, Michael Barry
AU - Uy, Natalie
AU - Valeri, Anthony
AU - Vena, Natalie
AU - Foroncewicz, Bartosz
AU - Moszczuk, Barbara
AU - Mucha, Krzysztof
AU - Perkowska-Ptasińska, Agnieszka
AU - Ghiggeri, Gian Marco
AU - Ambruzs, Josephine
AU - Liapis, Helen
AU - Baracco, Rossana
AU - Jain, Amrish
AU - Ashoor, Isa
AU - Srivastava, Tarak
AU - Ahn, Sun Young
AU - Devarajan, Prasad
AU - Erkan, Elif
AU - Claes, Donna
AU - Stone, Hillarey
AU - Mason, Sherene
AU - Silva, Cynthia
AU - Gomez-Mendez, Liliana
AU - Wang, Chia shi
AU - Yin, Hong (Julie)
AU - Jens, Goebel
AU - Steinke, Julia
AU - Cramer, Carl
AU - Pan, Cindy
AU - Sreedharan, Rajasree
AU - Bowers, Corinna
AU - Dreher, Mary
AU - Kallash, Mahmoud
AU - Mahan, John
AU - Sharpe, Samantha
AU - Smoyer, William
AU - Al-Uzri, Amira
AU - Belsha, Craig
AU - Braun, Michael
AU - Gomez, A. C.
AU - Feig, Daniel
N1 - Publisher Copyright:
© 2022 National Kidney Foundation, Inc.
PY - 2023/3
Y1 - 2023/3
N2 - Rationale & Objective: The effects of race, ethnicity, socioeconomic status (SES), and disease severity on acute care utilization in patients with glomerular disease are unknown. Study Design: Prospective cohort study. Setting & Participants: 1,456 adults and 768 children with biopsy-proven glomerular disease enrolled in the Cure Glomerulonephropathy (CureGN) cohort. Exposure: Race and ethnicity as a participant-reported social factor. Outcome: Acute care utilization 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 acute care utilization. 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. Limitations: We used proxies for SES and lacked direct information on income, household unemployment, or disability. 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.
AB - Rationale & Objective: The effects of race, ethnicity, socioeconomic status (SES), and disease severity on acute care utilization in patients with glomerular disease are unknown. Study Design: Prospective cohort study. Setting & Participants: 1,456 adults and 768 children with biopsy-proven glomerular disease enrolled in the Cure Glomerulonephropathy (CureGN) cohort. Exposure: Race and ethnicity as a participant-reported social factor. Outcome: Acute care utilization 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 acute care utilization. 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. Limitations: We used proxies for SES and lacked direct information on income, household unemployment, or disability. 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.
KW - acute care utilization (ACU)
KW - adults
KW - children
KW - ED visit
KW - emergency department (ED)
KW - Glomerular disease
KW - health care disparity
KW - hospitalization
KW - modifiable risk factor
KW - pediatric
KW - racial and ethnic disparities
KW - social determinants of health (SDOH)
KW - socioeconomic status (SES)
UR - https://www.scopus.com/pages/publications/85143280065
U2 - 10.1053/j.ajkd.2022.08.010
DO - 10.1053/j.ajkd.2022.08.010
M3 - Article
C2 - 36191724
AN - SCOPUS:85143280065
SN - 0272-6386
VL - 81
SP - 318-328.e1
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 3
ER -
SDG 10 Reduced Inequalities