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Racial and Ethnic Disparities in Acute Care Utilization Among Patients With Glomerular Disease
Journal article   Peer reviewed

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

Jill R. Krissberg, Michelle M. O’Shaughnessy, Abigail R. Smith, Margaret E. Helmuth, Salem Almaani, Diego H. Aviles, Kaye E. Brathwaite, Yi Cai, Daniel Cattran, Rasheed Gbadegesin, …
American journal of kidney diseases, Vol.81(3), pp.318-328.e1
10/2022
DOI: 10.1053/j.ajkd.2022.08.010
PMCID: PMC9974571
PMID: 36191724

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

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