Neighborhood socioeconomic status shows no impact on quality of kidney care
Click Here to Manage Email Alerts
For patients with chronic kidney disease residing in a metropolitan area of Minnesota, kidney care quality showed no significant variation based on neighborhood socioeconomic status.
“There is strong evidence of the association between neighborhood socioeconomic status (SES) and individuals’ health,” Lama Ghazi, MD, PhD, of Yale University School of Medicine, and colleagues wrote. “Individuals who live in disadvantaged neighborhoods have worse self-reported health, more comorbidities, higher mortality rates and even poorer dialysis outcomes than those who live in more advantaged neighborhoods. Previous studies have found that low neighborhood SES is associated with worse quality of care for cardiovascular diseases (CVD) and diabetes. However, there is a paucity of data on the role of neighborhood SES on kidney disease care, specifically early stages of CKD.”
The researchers cited the policy known as Healthy People 2020 as a potential gauge for how well CKD care is performed. The criteria they measured performance by included a prescription for converting enzyme inhibitor (ACEi) or angiotension receptor blockers (ARBs) for appropriate patients, urine albumin-to-creatinine ratio (UACR) measurement among patients with lab-identified CKD and CKD documented in an electronic health record.
Researchers reviewed EHR data related to 185,269 patients with creatinine measurements who visited a primary care physician in the Minneapolis/St Paul area; patients were categorized by census tract with wealth, income and education serving as neighborhood SES measures.
Results indicated the overall quality of kidney care was moderate to low, with 35% of patients with hypertension and CKD not having a prescription for ACEis or ARBs (patients who were prescribed these medications had more comorbidities than those who did not). In addition, UACR was not measured in 73% of patients with lab-identified CKD and 45% of patients with lab-identified CKD did not have it documented as such in the EHR.
“Those who had UACR measured vs. not were older, more likely to be Black, had more comorbidities and a higher percentage lived in lower neighborhood SES,” the researchers wrote. “As for patients who had CKD identified in the EHR vs. not, they were older, more likely to be male and Black, have more comorbidities and a higher percentage lived in lower neighborhood SES.”
Researchers noted that despite the aforementioned differences, quality of care was similar across all quartiles of neighborhood SES measures, as well as by race.
“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,” the researchers wrote.
Ghazi and colleagues added, “In conclusion, overall quality of care in patients with CKD can be greatly improved. EHRs can be leveraged to assess adherence to evidence-based screening and treatment guidelines in the care of patients with CKD and can target providers, the health care system and patients ... Quality improvement initiatives focusing on prevention, screening and improved management of patients with multiple comorbid conditions are needed.”
Collapse
Read more about
Click Here to Manage Email Alerts