High CKD treatment costs leads to reduced medical adherence among Black patients
Black patients with chronic kidney disease may be less likely to adhere to medical treatment compared with non-Black patients due to the financial burden medical care puts on available funds for basic needs, according to a study.
The research, published in Kidney Medicine, suggests that high out-of-pocket costs can lead to lower medical adherence by patients with CKD, but few studies have explored the association between race, socioeconomic status (SES) and medical care spending patterns.
“As the population of patients with multiple concomitant chronic diseases continues to grow, understanding whether financial barriers impact adherence to medical care is critical to improving outcomes,” Leah Machen, MD, from the division of general internal edicine at the University of California, and colleagues wrote. “In a diverse cohort of primary care patients with diabetes, hypertension and early CKD, we sought to determine the relation of personal expenditures for medical care, and to determine if these relations differed by race and SES.”
In a cross-sectional evaluation of baseline data from a randomized controlled trial, Machen and colleagues investigated the association between SES, race and medical spending among individuals with multiple comorbid conditions. The study was conducted in Durham, North Carolina, and nearly all 263 patients (mean age, 61.8; 52.7% men) were insured.
Data was analyzed from the Simultaneous Risk Factor Control Using Telehealth to slOw Progression of Diabetic Kidney Disease (STOP-DKD) study. Participants of the STOP-DKD study completed survey assessments regarding measures of socio-demographics, comorbidities, medical care expenditures and medication adherence. All participants were primary care patients with diabetes, hypertension or chronic kidney disease.
Using separate multivariable logistic regression models, researchers evaluated the relationship between race and each medical care spending outcome, adjusting for age, sex, income, education, employment and household chaos.
Of the 281 STOP-DKD baseline participants, only 263 were included in the final analytic cohort due to missing data. Compared with the remaining 119 non-Black participants, survey results revealed that the 144 Black participants were more likely to decrease spending on basic needs (29.2% vs. 13.5%) and leisure activities (35.4% vs. 20.2%) and to skip medications (31.3% vs. 15.1%), all p<0.05. The multivariable adjustment revealed that Black participants correlated with “increased odds” of decreased basic spending (OR=2.29 [95% CI, 1.14, 4.6]), reduced leisure spending (1.94 [1.05, 3.58]) and skipping medications (2.12 [1.12, 4.04]).
“The results of this study indicate that Black race is an independent predictor of medical spending difficulty, highlighting important contributors to disparate health outcomes of Black as compared [with] white individuals,” Machen and colleagues wrote. “These findings suggest that racial minorities with decreased kidney function remain highly vulnerable to the adverse health outcomes of CKD, warranting a comprehensive, patient-centered approach to CKD care that is responsive to, and respectful of, the unique needs of each individual.
“Moving forward,” they continued, “a more comprehensive assessment of barriers and facilitators to medical care spending is needed to inform system level interventions to attenuate the poor health outcomes of high risk, Black populations with multiple comorbid conditions.”
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Machen L, et al. Kidney Med. 2021;doi: 10.1016/j.xkme.2021.08.016.