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

CureGN Consortium

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)318-328.e1
JournalAmerican Journal of Kidney Diseases
Volume81
Issue number3
DOIs
StatePublished - Mar 2023

Bibliographical note

Funding Information:
Members listed by CureGN Participating Clinical Center network or as part of the Data Coordinating Center. Columbia University network: Wooin Ahn, Gerald Appel, Paul Appelbaum, Revekka Babayev, Andrew Bomback, Eric Brown, Pietro Canetta, Lucrezia Carlassara, Brenda Chan, Vivette Denise D'Agati, Samitri Dogra, Hilda Fernandez, Ali Gharavi,∗∗ William Hines, Syed Ali Husain, Krzysztof Kiryluk, Fangming Lin, Maddalena Marasa,# Glen Markowitz, Hila Milo Rasouly, Sumit Mohan, Nicola Mongera, Thomas Nickolas, Jai Radhakrishnan, Maya Rao, Simone Sanna-Cherchi, Shayan Shirazian, Michael Barry Stokes, Natalie Uy, Anthony Valeri, Natalie Vena (Columbia University, New York, NY); Bartosz Foroncewicz, Barbara Moszczuk, Krzysztof Mucha,∗ Agnieszka Perkowska-Ptasińska (University of Warsaw, Warszawa, Poland); Gian Marco Ghiggeri∗ (Gaslini Children's Hospital, Genoa, Italy). Midwest Pediatric Nephrology Consortium: Josephine Ambruzs, Helen Liapis (Arkana Laboratories, Little Rock, AR); Rossana Baracco, Amrish Jain∗ (Children's Hospital of Michigan, Detroit, MI); Isa Ashoor (Children's Hospital of New Orleans/LSU Health, New Orleans, LA); Tarak Srivastava∗ (Children's Mercy Hospital, Kansas City, MO); Sun-Young Ahn∗ (Children's National Medical Center, Washington, DC); Prasad Devarajan, Elif Erkan,∗ Donna Claes, Hillarey Stone (Cincinnati Children's Hospital, Cincinnati, OH); Sherene Mason,∗ Cynthia Silva (Connecticut Children's Medical Center, Hartford, CT); Liliana Gomez-Mendez∗ (East Carolina University Brody School of Medicine, Greenville, SC); Chia-shi Wang, Hong (Julie) Yin (Emory University, Atlanta, GA); Goebel Jens, Julia Steinke (Helen DeVos Children's Hospital, Grand Rapids, MI); Carl Cramer∗ (Mayo Clinic, Rochester, MN); Cindy Pan, Rajasree Sreedharan∗ (Medical College of Wisconsin, Milwaukee, WI); Corinna Bowers,# Mary Dreher,# Mahmoud Kallash,∗ John Mahan, Samantha Sharpe,# William Smoyer∗∗ (Nationwide Children's Hospital, Columbus, OH); Amira Al-Uzri∗ (Oregon Health and Science University, Portland, OR); Craig Belsha∗ (Cardinal Glennon Children's Medical Center/St Louis University, St Louis, MO); Michael Braun, AC Gomez (Texas Children's Hospital, Houston, TX); Daniel Feig∗ (Children's of Alabama, University of Alabama, Birmingham, AL); Gabriel Cara Fuentes, Melisha Hannah∗ (University of Colorado Children's Hospital, Colorado, Aurora, CO); Carla Nester∗ (University of Iowa Children's Hospital, Iowa City, IA); Aftab Chishti∗ (University of Kentucky, Lexington, KY); Jon Klein∗∗ (University of Louisville, Louisville, KY); Chryso Katsoufis, Wacharee Seeherunvong∗ (Holtz Medical Center, University of Miami, Miami, FL); Michelle Rheault∗ (University of Minnesota Children's Hospital, Minneapolis, MN); Craig Wong∗ (University of New Mexico Health Sciences Center, Albuquerque, NM); Nisha Mathews∗ (University of Oklahoma Health Sciences Center, Oklahoma City, OK); John Barcia,∗ Agnes Swiatecka-Urban (University of Virginia, Charlottesville, VA); Sharon Bartosh∗ (University of Wisconsin, Madison, WI); Tracy Hunley∗ (Vanderbilt Children's Hospital, Nashville, TN); Vikas Dharnidharka,∗ Joseph Gaut (Washington University in St Louis, St Louis, MO). University of North Carolina network: Louis-Philippe Laurin,∗ Virginie Royal (Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada); Anand Achanti, Milos Budisavljevic,∗ Sally Self (Medical University of South Carolina, Charleston, SC); Cybele Ghossein, Shikha Wadhwani∗ (Northwestern University, Chicago, IL); Isabelle Ayoub, Tibor Nadasdy, Samir, Parikh, Brad Rovin∗ (Ohio State University, Columbus, OH); Anthony Chang (University of Chicago, Chicago, IL); Huma Fatima, Jan Novak, Matthew Renfrow, Dana Rizk∗ (University of Alabama at Birmingham, Birmingham, AL); Dhruti Chen, Vimal Derebail, Ronald Falk,∗∗ Keisha Gibson, Susan Hogan, Koyal Jain, J. Charles Jennette, Amy Mottl,∗ Caroline Poulton,# Manish Kanti Saha (University of North Carolina Kidney Center, Chapel Hill, NC); Agnes Fogo, Neil Sanghani∗ (Vanderbilt University, Nashville, TN); Jason Kidd,∗ Hugh Massey, Selvaraj Muthusamy (Virginia Commonwealth University, Richmond, VA). University of Pennsylvania network: Santhi Ganesan, Agustin Gonzalez-Vicente, Jeffrey Schelling∗ (MetroHealth Medical Center/Case Western Reserve University, Cleveland, OH); Jean Hou (Cedars-Sinai Health System, Los Angeles, CA); Kevin Lemley,∗ Warren Mika, Pierre Russo (Children's Hospital of LA, Los Angeles, CA); Michelle Denburg, Amy Kogon, Kevin Meyers,∗ Madhura Pradhan (Children's Hospital of Philadelphia, Philadelphia, PA); Raed Bou Matar,∗ John O'Toole,∗ John Sedor∗ (Cleveland Clinic, Cleveland, OH); Serena Bagnasco, Alicia Neu (Johns Hopkins University, Baltimore, MD); Sharon Adler,∗ Tiane Dai, Ram Dukkipati (Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA); Fernando Fervenza,∗ Sanjeev Sethi (Mayo Clinic, Rochester, MN); Frederick Kaskel (Montefiore Medical Center, New York, NY); Suzanne Vento,# Joseph Weisstuch, Ming Wu, Olga Zhdanova (New York University, New York, NY); Jurgen Heymann, Meryl Waldman, Cheryl Winkler (National Institute of Diabetes and Digestive and Kidney Diseases [NIDDK], Bethesda, MD); Michelle Hladunewich∗ (Sunnybrook Health Sciences Centre, Toronto, ON, Canada); Carmen Avila-Casado, Daniel Cattran,∗ Reich Heather, Philip Boll (University Health Network, Toronto, ON, Canada); Yelena Drexler, Alessia Fornoni∗ (University of Miami, Miami, FL); Patrick Gipson,∗ Jeffrey Hodgin, Andrew Oliverio (University of Michigan, Ann Arbor, MI); Jon Hogan, Lawrence Holzman,∗∗ Matthew Palmer (University of Pennsylvania, Philadelphia, PA); Blaise Abromovitz,∗ Michael Mortiz∗ (University of Pittsburgh School of Medicine, Pittsburgh, PA); Charles Alpers, J. Ashley Jefferson∗ (University of Washington, Seattle, WA); Elizabeth Brown, Kamal Sambandam∗ (UT Southwestern, Dallas, TX). Data Coordinating Center: Bruce Robinson∗∗ (Arbor Research Collaborative for Health, Ann Arbor, MI); Cynthia Nast (Cedar Sinai Medical Center, Los Angeles, CA); Laura Barisoni (Duke University, Durham, NC); Brenda Gillespie,∗∗ Deb Gipson,∗∗ Maggie Hicken, Matthias Kretzler,∗∗ Laura Mariani (University of Michigan, Ann Arbor, MI). Steering Committee Chair: Lisa M. Guay-Woodford (Children's National Hospital, Washington, DC). ∗CureGN Site Principal Investigator [PI]; ∗∗CureGN PI; #CureGN Lead Coordinator. Authors Krissberg, Smith, Almaani, Aviles∗, Brathwaite, Cai,∗ Cattran,∗ Gbadegesin,∗ Greenbaum,∗∗ Iragorri, Jain, Khalid,∗ Kidd,∗ Kopp,∗ Lafayette,∗ Lane,∗ Lugani, Nestor, Parekh,∗ Reidy,∗ Selewski, Sethna,∗ Sperati,∗ Tuttle,∗ Twombley,∗ Vasylyeva,∗ Weaver,∗ Wenderfer,∗ and Gibson are also members of the CureGN Consortium (∗site PI; ∗∗CureGN PI). Jill R. Krissberg, MD, MS, Michelle M. O'Shaughnessy, MB BCh BAO, MS, Abigail R. Smith, PhD, Margaret E. Helmuth, MS, Salem Almaani, MD, MS, Diego H. Aviles, MD, Kaye E. Brathwaite, MD, Yi Cai, MD, PhD, Daniel Cattran, MD, Rasheed Gbadegesin, MD, Dorey A. Glenn, MD, MPH, Larry A. Greenbaum, MD, PhD, Sandra Iragorri, MD, Koyal Jain, MD, MPH, Myda Khalid, MD, Jason Kidd, MD, Jeffrey Kopp, MD, Richard Lafayette, MD, Jerome C. Lane, MD, Francesca Lugani, MD, PhD, Jordan G. Nestor, MD, Rulan S. Parekh, MD, Kimberly Reidy, MD, David T. Selewski, MD, MS, Christine B. Sethna, MD, C. John Sperati, MD, MHS, Katherine Tuttle, MD, Katherine Twombley, MD, Tetyana L. Vasylyeva, MD, PhD, Donald J Weaver Jr, MD, PhD, Scott E. Wenderfer, MD, PhD, and Keisha Gibson, MD, MPH. Concept and design: JRK, MMO, KG; data acquisition, analysis: MEH and ARS; administrative, technical, and material support: MEH and ARS; interpretation of results: all authors; supervision: MMO, ARS, KG. Each author contributed important intellectual content during manuscript drafting or revision and agrees to be personally accountable for the individual's own contributions and to ensure that questions pertaining to the accuracy or integrity of any portion of the work, even one in which the author was not directly involved, are appropriately investigated and resolved, including with documentation in the literature if appropriate. Funding for the CureGN consortium is provided by U24DK100845 (formerly UM1DK100845), U01DK100846 (formerly UM1DK100846), U01DK100876 (formerly UM1DK100876), U01DK100866 (formerly UM1DK100866), and U01DK100867 (formerly UM1DK100867) from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Patient recruitment is supported by NephCure Kidney International. Dates of funding for the first phase of CureGN was September 16, 2013, through May 31, 2019. Dr Krissberg was a Tashia and John Morgridge Endowed Postdoctoral Fellow of the Stanford Maternal and Child Health Research Institute at the time this study was completed. Dr Brathwaite is supported by NIDDK T32 Diversity Supplement Award T32DK007110-47S1. Dr Nestor is supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through grant KL2TR001874. The funders had no role in study design; data collection, analysis, or reporting; or the decision to submit for publication. Dr Almaani has received research support from Gilead Sciences and personal fees for Aurinia and Kezar Life Sciences. Dr Greenbaum has received research support from Vertex Pharmaceuticals and Reata Pharmaceuticals and has served as a consultant for Aurinia, Roche Pharmaceuticals, and Novartis. Dr Selewski has served as a consultant for Travere. Dr Gibson has served as a consultant for Aurinia Inc, Travere Inc (formally Retrophin), and Reata Inc. The remaining authors declare that they have no relevant financial interests. We acknowledge the efforts of all CureGN participants, their parents, investigators, and staff. Data are available in a repository at the NIDDK central repository at https://repository.niddk.nih.gov/home/ and can be accessed using the unique identifier CureGN. Received January 28, 2022. Evaluated by 2 external peer reviewers, with direct editorial input from a Statistics/Methods Editor and an Associate Editor who served as Acting Editor-in-Chief. Accepted in revised form August 3, 2022. The involvement of an Acting Editor-in-Chief was to comply with AJKD's procedures for potential conflicts of interest for editors, described in the Information for Authors & Journal Policies.

Funding Information:
Funding for the CureGN consortium is provided by U24DK100845 (formerly UM1DK100845), U01DK100846 (formerly UM1DK100846), U01DK100876 (formerly UM1DK100876), U01DK100866 (formerly UM1DK100866), and U01DK100867 (formerly UM1DK100867) from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Patient recruitment is supported by NephCure Kidney International. Dates of funding for the first phase of CureGN was September 16, 2013, through May 31, 2019. Dr Krissberg was a Tashia and John Morgridge Endowed Postdoctoral Fellow of the Stanford Maternal and Child Health Research Institute at the time this study was completed. Dr Brathwaite is supported by NIDDK T32 Diversity Supplement Award T32DK007110-47S1. Dr Nestor is supported by the National Center for Advancing Translational Sciences, National Institutes of Health , through grant KL2TR001874. The funders had no role in study design; data collection, analysis, or reporting; or the decision to submit for publication.

Publisher Copyright:
© 2022 National Kidney Foundation, Inc.

Keywords

  • ED visit
  • Glomerular disease
  • acute care utilization (ACU)
  • adults
  • children
  • emergency department (ED)
  • health care disparity
  • hospitalization
  • modifiable risk factor
  • pediatric
  • racial and ethnic disparities
  • social determinants of health (SDOH)
  • socioeconomic status (SES)

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