Race Differences in Access to Health Care and Disparities in Incident Chronic Kidney Disease in the US

Overview

Journal Nephrol Dial Transplant

Publisher Oxford University Press

Specialties General Surgery
Nephrology

Date 2010 Aug 7

PMID 20688771

Citations 40

Authors

Kira Evans

Josef Coresh

Lori D Bash

Tiffany Gary-Webb

Anna Kottgen

Kathryn Carson

L Ebony Boulware

Affiliations

Soon will be listed here.

Abstract

Background: The contribution of race differences in access to health care to disparities in chronic kidney disease (CKD) incidence in the United States is unknown.

Methods: We examined race differences in usual source of health care, health insurance and CKD incidence among 3883 Whites and 1607 Blacks with hypertension or diabetes enrolled in the Atherosclerosis Risk in Communities Study. In multivariable analyses, we explored the incremental contribution of access to health care in explaining Blacks' excess CKD incidence above and beyond other socioeconomic, lifestyle and clinical factors.

Results: Compared with Whites, Blacks had poorer access to health care (3 vs 0.3% with no usual source of health care or health insurance, P < 0.001) and experienced greater CKD incidence (14.7 vs 12.0 cases per 1000 person-years, P < 0.001). Blacks' excess risk of CKD persisted after adjusting for demographic, socioeconomic, lifestyle and clinical factors [hazard ratio (HR) (95% confidence interval (95% CI)) = 1.21 (1.01-1.47)]. Adjustment for these factors explained 64% of the excess risk among Blacks. The increased risk for CKD among Blacks was attenuated after additional adjustment for race differences in access to health care [HR (95% CI) = 1.19 (0.99-1.45)], which explained an additional 10% of the disparity. Conclusions. In this population at risk for developing CKD, we found that poorer access to health care among Blacks explained some of Blacks' excess risk of CKD, beyond the excess risk explained by demographic, socioeconomic, lifestyle and clinical factors. Improved access to health care for high-risk individuals could narrow disparities in CKD incidence.

Citing Articles

Socioeconomic disparities in kidney transplant access for patients with end-stage kidney disease within the All of Us Research Program.

Wang J, Cho K, Tantisattamo E J Am Med Inform Assoc. 2024; 31(12):2781-2788.

PMID: 39222370 PMC: 11631050. DOI: 10.1093/jamia/ocae178.

Racial/Ethnic, Sex, and Economic Disparities in the Utilization and Outcomes of Intracoronary Imaging.

Ismayl M, Ahmed H, Goldsweig A, Alkhouli M, Prasad A, Guerrero M J Soc Cardiovasc Angiogr Interv. 2024; 3(6):101936.

PMID: 39132585 PMC: 11308510. DOI: 10.1016/j.jscai.2024.101936.

Finerenone in Black Patients With Type 2 Diabetes and CKD: A Post hoc Analysis of the Pooled FIDELIO-DKD and FIGARO-DKD Trials.

Flack J, Agarwal R, Anker S, Pitt B, Ruilope L, Rossing P Kidney Med. 2023; 5(12):100730.

PMID: 38046911 PMC: 10692708. DOI: 10.1016/j.xkme.2023.100730.

Testing the Differential Access Hypothesis That Black Kidney Transplant Candidates Perceive Social Network Access to Fewer Potential Living Donors Than White Candidates.

Daw J, Roberts M, Gillespie A, Verdery A, Purnell T Prog Transplant. 2023; 33(2):130-140.

PMID: 36942427 PMC: 10150261. DOI: 10.1177/15269248231164174.

Prevalence of anaemia in adults with chronic kidney disease in a representative sample of the United States population: analysis of the 1999-2018 National Health and Nutrition Examination Survey.

Kovesdy C, Davis J, Duling I, Little D Clin Kidney J. 2023; 16(2):303-311.

PMID: 36755833 PMC: 9900579. DOI: 10.1093/ckj/sfac240.

References

Benoit S, Fleming R, Philis-Tsimikas A, Ji M . Predictors of glycemic control among patients with Type 2 diabetes: a longitudinal study. BMC Public Health. 2005; 5:36. PMC: 1090595. DOI: 10.1186/1471-2458-5-36. View

Newacheck P, Hughes D, Stoddard J . Children's access to primary care: differences by race, income, and insurance status. Pediatrics. 1996; 97(1):26-32. View

Brancati F, Whittle J, Whelton P, Seidler A, Klag M . The excess incidence of diabetic end-stage renal disease among blacks. A population-based study of potential explanatory factors. JAMA. 1992; 268(21):3079-84. View

Gandelman G, Aronow W, Varma R . Prevalence of adequate blood pressure control in self-pay or Medicare patients versus Medicaid or private insurance patients with systemic hypertension followed in a university cardiology or general medicine clinic. Am J Cardiol. 2004; 94(6):815-6. DOI: 10.1016/j.amjcard.2004.06.012. View

Hargraves J, Hadley J . The contribution of insurance coverage and community resources to reducing racial/ethnic disparities in access to care. Health Serv Res. 2003; 38(3):809-29. PMC: 1360918. DOI: 10.1111/1475-6773.00148. View

Pol L, Mueller K, Adidam P . Racial and ethnic differences in health insurance for the near elderly. J Health Care Poor Underserved. 2002; 13(2):229-40. DOI: 10.1353/hpu.2010.0543. View

Levey A, Stevens L, Schmid C, Zhang Y, Castro 3rd A, Feldman H . A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009; 150(9):604-12. PMC: 2763564. DOI: 10.7326/0003-4819-150-9-200905050-00006. View

. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. National Diabetes Data Group. Diabetes. 1979; 28(12):1039-57. DOI: 10.2337/diab.28.12.1039. View

Roetzheim R, Gonzalez E, Ferrante J, Pal N, van Durme D, Krischer J . Effects of health insurance and race on breast carcinoma treatments and outcomes. Cancer. 2001; 89(11):2202-13. DOI: 10.1002/1097-0142(20001201)89:11<2202::aid-cncr8>3.0.co;2-l. View

10.

Bash L, Erlinger T, Coresh J, Marsh-Manzi J, Folsom A, Astor B . Inflammation, hemostasis, and the risk of kidney function decline in the Atherosclerosis Risk in Communities (ARIC) Study. Am J Kidney Dis. 2008; 53(4):596-605. PMC: 2778194. DOI: 10.1053/j.ajkd.2008.10.044. View

11.

Delaet D, Shea S, Carrasquillo O . Receipt of preventive services among privately insured minorities in managed care versus fee-for-service insurance plans. J Gen Intern Med. 2002; 17(6):451-7. PMC: 1495058. DOI: 10.1046/j.1525-1497.2002.10512.x. View

12.

Lavernia C, Lee D, Sierra R, Gomez-Marin O . Race, ethnicity, insurance coverage, and preoperative status of hip and knee surgical patients. J Arthroplasty. 2004; 19(8):978-85. DOI: 10.1016/j.arth.2004.03.028. View

13.

Bowker S, Mitchell C, Majumdar S, Toth E, Johnson J . Lack of insurance coverage for testing supplies is associated with poorer glycemic control in patients with type 2 diabetes. CMAJ. 2004; 171(1):39-43. PMC: 437682. DOI: 10.1503/cmaj.1031830. View

14.

Weinick R, Krauss N . Racial/ethnic differences in children's access to care. Am J Public Health. 2000; 90(11):1771-4. PMC: 1446405. DOI: 10.2105/ajph.90.11.1771. View

15.

Shoham D, Vupputuri S, Diez Roux A, Kaufman J, Coresh J, Kshirsagar A . Kidney disease in life-course socioeconomic context: the Atherosclerosis Risk in Communities (ARIC) Study. Am J Kidney Dis. 2007; 49(2):217-26. DOI: 10.1053/j.ajkd.2006.11.031. View

16.

Zuvekas S, Weinick R . Changes in access to care, 1977-1996: the role of health insurance. Health Serv Res. 1999; 34(1 Pt 2):271-9. PMC: 1089000. View

17.

. The Atherosclerosis Risk in Communities (ARIC) Study: design and objectives. The ARIC investigators. Am J Epidemiol. 1989; 129(4):687-702. View

18.

Rhee M, Cook C, Dunbar V, Panayioto R, Berkowitz K, Boyd B . Limited health care access impairs glycemic control in low income urban African Americans with type 2 diabetes. J Health Care Poor Underserved. 2005; 16(4):734-46. DOI: 10.1353/hpu.2005.0100. View

19.

Hargraves J . The insurance gap and minority health care, 1997-2001. Track Rep. 2003; (2):1-4. View

20.

. The 1988 report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med. 1988; 148(5):1023-38. View