Racial/Ethnic Inequities in Access to High-Quality Dialysis Treatment in Chicago: Does Neighborhood Racial/Ethnic Composition Matter?

Overview

Journal J Racial Ethn Health Disparities

Specialties Public Health
Social Sciences

Date 2020 Feb 7

PMID 32026285

Citations 9

Authors

Haena Lee

Julia T Caldwell

Chieko Maene

Kathleen A Cagney

Milda R Saunders

Affiliations

Soon will be listed here.

Abstract

Objectives: Blacks and Hispanics face a higher incidence rate of end-stage renal disease (ESRD) and tend to experience poorer access to quality health care compared with Whites. Income, education, and insurance coverage differentials are typically identified as risk factors, but neighborhood-level analyses may provide additional insights. We examine whether neighborhood racial composition contributes to racial/ethnic inequities in access to high-quality dialysis care in Chicago.

Methods: Data are drawn from the United States Renal Data System merged to the ESRD Quality Incentive Program file and the American Community Survey (2005-2009) for facility and neighborhood characteristics (N = 2797). Outcomes included (1) spatial access (travel time to dialysis facilities) and (2) realized access (actual use of quality care). Neighborhood racial/ethnic composition was categorized into four types: predominantly White, Black, and Hispanic neighborhoods, and racially integrated neighborhoods.

Results: Blacks lived closer to a dialysis facility but traveled the same distance to their own dialysis compared with Whites. Hispanics had longer travel time to any dialysis than Whites, and the difference between Hispanics and Whites became no longer significant after adjusting for neighborhood racial/ethnic composition. Blacks and Hispanics had better access to a high-quality facility if they lived in integrated neighborhoods (OR = 1.85 and 3.77, respectively, p < 0.01) or in neighborhoods with higher concentrations of their own race/ethnicity (OR = 1.68 for Blacks in Black neighborhoods and 1.92 for Hispanics in Hispanic neighborhoods, p < 0.05) compared with Whites in predominantly White neighborhoods.

Conclusion: Expanding opportunities for Blacks and Hispanics to gain access to racially integrated and minority neighborhoods may help alleviate racial/ethnic inequities in access to quality care among kidney disease patients.

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References

Saunders M, Lee H, Maene C, Schuble T, Cagney K . Proximity Does Not Equal Access: Racial Disparities in Access to High Quality Dialysis Facilities. J Racial Ethn Health Disparities. 2014; 1(4):291-299. PMC: 4238970. DOI: 10.1007/s40615-014-0036-0. View

Saran R, Robinson B, Abbott K, Agodoa L, Albertus P, Ayanian J . US Renal Data System 2016 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis. 2017; 69(3 Suppl 1):A7-A8. PMC: 6605045. DOI: 10.1053/j.ajkd.2016.12.004. View

Purnell T, Luo X, Cooper L, Massie A, Kucirka L, Henderson M . Association of Race and Ethnicity With Live Donor Kidney Transplantation in the United States From 1995 to 2014. JAMA. 2018; 319(1):49-61. PMC: 5833543. DOI: 10.1001/jama.2017.19152. View

Saunders M, Lee H, Chin M . Early winners and losers in dialysis center pay-for-performance. BMC Health Serv Res. 2017; 17(1):816. PMC: 5721658. DOI: 10.1186/s12913-017-2764-4. View

Gaskin D, Dinwiddie G, Chan K, McCleary R . Residential segregation and disparities in health care services utilization. Med Care Res Rev. 2011; 69(2):158-75. PMC: 3387667. DOI: 10.1177/1077558711420263. View

Ho K, Moy E, Clancy C . Can incentives to improve quality reduce disparities?. Health Serv Res. 2010; 45(1):1-5. PMC: 2813433. DOI: 10.1111/j.1475-6773.2009.01076.x. View

Bower K, Thorpe Jr R, Rohde C, Gaskin D . The intersection of neighborhood racial segregation, poverty, and urbanicity and its impact on food store availability in the United States. Prev Med. 2013; 58:33-9. PMC: 3970577. DOI: 10.1016/j.ypmed.2013.10.010. View

Morland K, Wing S, Roux A, Poole C . Neighborhood characteristics associated with the location of food stores and food service places. Am J Prev Med. 2002; 22(1):23-9. DOI: 10.1016/s0749-3797(01)00403-2. View

Rodriguez R, Sen S, Mehta K, Moody-Ayers S, Bacchetti P, OHare A . Geography matters: relationships among urban residential segregation, dialysis facilities, and patient outcomes. Ann Intern Med. 2007; 146(7):493-501. DOI: 10.7326/0003-4819-146-7-200704030-00005. View

10.

Zhang X, Melanson T, Plantinga L, Basu M, Pastan S, Mohan S . Racial/ethnic disparities in waitlisting for deceased donor kidney transplantation 1 year after implementation of the new national kidney allocation system. Am J Transplant. 2018; 18(8):1936-1946. PMC: 6105401. DOI: 10.1111/ajt.14748. View

11.

Keith D, Ashby V, Port F, Leichtman A . Insurance type and minority status associated with large disparities in prelisting dialysis among candidates for kidney transplantation. Clin J Am Soc Nephrol. 2008; 3(2):463-70. PMC: 2390941. DOI: 10.2215/CJN.02220507. View

12.

Martin D, Wrigley H, Barnett S, Roderick P . Increasing the sophistication of access measurement in a rural healthcare study. Health Place. 2002; 8(1):3-13. DOI: 10.1016/s1353-8292(01)00031-4. View

13.

. Medicare program; end-stage renal disease prospective payment system. Final rule. Fed Regist. 2010; 75(155):49029-214. View

14.

Gary T, Stark S, LaVeist T . Neighborhood characteristics and mental health among African Americans and whites living in a racially integrated urban community. Health Place. 2006; 13(2):569-75. DOI: 10.1016/j.healthplace.2006.06.001. View

15.

Riley A . Neighborhood Disadvantage, Residential Segregation, and Beyond-Lessons for Studying Structural Racism and Health. J Racial Ethn Health Disparities. 2017; 5(2):357-365. DOI: 10.1007/s40615-017-0378-5. View

16.

Logan J, Stults B, Farley R . Segregation of minorities in the metropolis: two decades of change. Demography. 2004; 41(1):1-22. DOI: 10.1353/dem.2004.0007. View

17.

Schaeffner E, Mehta J, Winkelmayer W . Educational level as a determinant of access to and outcomes after kidney transplantation in the United States. Am J Kidney Dis. 2008; 51(5):811-8. DOI: 10.1053/j.ajkd.2008.01.019. View

18.

Cohen J, Gabriel B, Terrell C . The case for diversity in the health care workforce. Health Aff (Millwood). 2002; 21(5):90-102. DOI: 10.1377/hlthaff.21.5.90. View

19.

Luo W, Wang F . Measures of Spatial Accessibility to Healthcare in a GIS Environment: Synthesis and a Case Study in Chicago Region. Environ Plann B Plann Des. 2021; 30(6):865-884. PMC: 8238135. DOI: 10.1068/b29120. View

20.

Dai D . Black residential segregation, disparities in spatial access to health care facilities, and late-stage breast cancer diagnosis in metropolitan Detroit. Health Place. 2010; 16(5):1038-52. DOI: 10.1016/j.healthplace.2010.06.012. View