Neighborhood Socioeconomic Status and Quality of Kidney Care: Data From Electronic Health Records

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Rational & Objective: Electronic health records can be leveraged to assess quality-of-care measures in patients with chronic kidney disease (CKD). Neighborhood socioeconomic status could be a potential barrier to receiving appropriate evidence-based therapy and follow-up. We examined whether neighborhood socioeconomic status is independently associated with quality of care received by patients with CKD.

Study Design: Observational study using electronic health record data.

Setting & Participants: Retrospective study of patients seen at a health care system in the 7-county Minneapolis/St Paul area.

Exposures: Census tract socioeconomic status measures (wealth, income, and education).

Outcomes: Indicators of CKD quality of care: (1) prescription for angiotensin-converting enzyme inhibitor/angiotensin receptor blocker in patients with stage ≥ 3 CKD or stage 1 or 2 CKD with urinary albumin-creatinine ratio (UACR) > 300 mg/d, (2) UACR measurement among patients with laboratory-based CKD (estimated glomerular filtration rate < 60 mL/min/1.72 m 2), and (3) CKD identified on the problem list or coded for at an encounter among patients with laboratory-based CKD.

Analytic Approach: Multilevel Poisson regression with robust error variance with a random intercept at the census tract level.

Results: Of the 16,776 patients who should be receiving an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, 65% were prescribed these medications. Among patients with laboratory-based CKD (n = 25,097), UACR was measured in 27% and CKD was identified in the electronic health record in 55%. We found no independent association between any neighborhood socioeconomic status measures and CKD quality-of-care indicators.

Limitations: 1 health care system and selection bias.

Conclusions: We found no association of neighborhood socioeconomic status with quality of CKD care in our cohort. However, adherence to CKD guidelines is low, indicating an opportunity to improve care for all patients regardless of neighborhood socioeconomic status.

Original languageEnglish (US)
Pages (from-to)515-527.e1
JournalKidney Medicine
Issue number4
StatePublished - Jul 1 2021

Bibliographical note

Funding Information:
This research was primarily supported by the National Institutes of Health (NIH) National Center for Advancing Translational Sciences, grant UL1TR002494, and the University of Minnesota Doctoral Dissertation Fellowship (for Dr Ghazi). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH National Center for Advancing Translational Sciences. Dr Osypuk was supported by the National Institute of Child Health and Human Development (R01HD090014). Dr MacLehose was supported by the US National Library of Medicine (R01LM013049). None of the funders had any role in the study design; data collection, analysis, or reporting; or decision to submit the application.

Publisher Copyright:
© 2021 The Authors


  • Chronic kidney disease
  • electronic health records
  • healthcare system
  • neighborhood socioeconomic status
  • quality of care


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