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American Journal of Kidney Diseases

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

Published:September 30, 2022DOI:https://doi.org/10.1053/j.ajkd.2022.08.010

      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.

      Graphical abstract

      Index Words

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