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

• DOI: 10.1053/j.ajkd.2022.08.010
• Publication Date: 2022-10-01T03:37:31Z
• Authors: Jill R. Krissberg; Michelle M. O’Sha...; Abigail R. Smith; Margaret E. Helmuth; Salem Almaani; Diego H. Aviles; Kaye E. Brathwaite; Yi Cai; Daniel Cattran; Rasheed Gbadegesin; Dorey A. Glenn; Larry A. Greenbaum; Sandra Iragorri; Koyal Jain; Myda Khalid; Jason Kidd; Jeffrey Kopp; Richard Lafayette; Jerome C. Lane; Francesca Lugani; Jordan G. Nestor; Rulan S. Parekh; Kimberly Reidy; David T. Selewski; Christine B. Sethna; C. John Sperati; Katherine Tuttle; Katherine Twombley; Tetyana L. Vasylyeva; Donald J. Weaver; Scott E. Wenderfer; Keisha Gibson; Wooin Ahn; Gerald Appel; Paul Appelbaum; Revekka Babayev; Andrew Bomback; Eric Brown; Pietro Canetta; Lucrezia Carlassara; Brenda Chan; Vivette Denise D’...; 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; Bartosz Foroncewicz; Barbara Moszczuk; Krzysztof Mucha; Agnieszka Perkows...; Gian Marco Ghiggeri; Josephine Ambruzs; Helen Liapis; Rossana Baracco; Amrish Jain; Isa Ashoor; Tarak Srivastava; Sun-Young Ahn; Prasad Devarajan; Elif Erkan; Donna Claes; Hillarey Stone; Sherene Mason; Cynthia Silva; Liliana Gomez-Mendez; Chia-shi Wang; Hong (Julie) Yin; Goebel Jens; Julia Steinke; Carl Cramer; Cindy Pan; Rajasree Sreedharan; Corinna Bowers; Mary Dreher; Mahmoud Kallash; John Mahan; Samantha Sharpe; William Smoyer; Amira Al-Uzri; Craig Belsha; Michael Braun; A.C. Gomez; Daniel Feig; Gabriel Cara Fuentes; Melisha Hannah; Carla Nester; Aftab Chishti; Jon Klein; Chryso Katsoufis; Wacharee Seeherun...; Michelle Rheault; Craig Wong; Nisha Mathews; John Barcia; Agnes Swiatecka-U...; Sharon Bartosh; Tracy Hunley; Vikas Dharnidharka; Joseph Gaut; Louis-Philippe La...; Virginie Royal; Anand Achanti; Milos Budisavljevic; Sally Self; Cybele Ghossein; Shikha Wadhwani; Isabelle Ayoub; Tibor Nadasdy; Samir Parikh; Brad Rovin; Anthony Chang; Huma Fatima; Jan Novak; Matthew Renfrow; Dana Rizk; Dhruti Chen; Vimal Derebail; Ronald Falk; Keisha Gibson; Susan Hogan; Koyal Jain; J. Charles Jennette; Amy Mottl; Caroline Poulton; Manish Kanti Saha; Agnes Fogo; Neil Sanghani; Jason Kidd; Hugh Massey; Selvaraj Muthusamy; Santhi Ganesan; Agustin Gonzalez-...; Jeffrey Schelling; Jean Hou; Kevin Lemley; Warren Mika; Pierre Russo; Michelle Denburg; Amy Kogon; Kevin Meyers; Madhura Pradhan; Raed Bou Matar; John O’Toole; John Sedor; Serena Bagnasco; Alicia Neu; Sharon Adler; Tiane Dai; Ram Dukkipati; Fernando Fervenza; Sanjeev Sethi; Frederick Kaskel; Suzanne Vento; Joseph Weisstuch; Ming Wu; Olga Zhdanova; Jurgen Heymann; Meryl Waldman; Cheryl Winkler; Michelle Hladunewich; Carmen Avila-Casado; Daniel Cattran; Reich Heather; Philip Boll; Yelena Drexler; Alessia Fornoni; Patrick Gipson; Jeffrey Hodgin; Andrew Oliverio; Jon Hogan; Lawrence Holzman; Matthew Palmer; Blaise Abromovitz; Michael Mortiz; Charles Alpers; J. Ashley Jefferson; Elizabeth Brown; Kamal Sambandam; Bruce Robinson; Cynthia Nast; Laura Barisoni; Brenda Gillespie; Deb Gipson; Maggie Hicken; Matthias Kretzler; Laura Mariani; Lisa M. Guay-Wood...
• Keywords: Adult; Black People; Hispanic or Latino; Patient Acceptance of Health Care; 16. Peace & justice; White People; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Social Class; Asian People; Ethnicity; Humans; Kidney Diseases; Prospective Studies; Healthcare Disparities; Child

The effects of race, ethnicity, socioeconomic status (SES), and disease severity on acute care utilization in patients with glomerular disease are unknown.Prospective cohort study.1,456 adults and 768 children with biopsy-proven glomerular disease enrolled in the Cure Glomerulonephropathy (CureGN) cohort.Race and ethnicity as a participant-reported social factor.Acute care utilization defined as hospitalizations or emergency department visits.Multivariable recurrent event proportional rate models were used to estimate associations between race and ethnicity and acute care utilization.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.We used proxies for SES and lacked direct information on income, household unemployment, or disability.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.