Abstract: FR-PO1032
Community Health Center Penetration and Kidney Outcomes among Nonelderly Adults with Incident ESKD
Session Information
- Social, Environmental, and Economic Determinants of Kidney Health
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diversity and Equity in Kidney Health
- 900 Diversity and Equity in Kidney Health
Authors
- Hall, Yoshio N., VA Puget Sound Health Care System Seattle Division, Seattle, Washington, United States
- Bensken, Wyatt P., Oregon Community Health Information Network, Portland, Oregon, United States
- Morrissey, Suzanne E., Oregon Community Health Information Network, Portland, Oregon, United States
- De la Cruz Alcantara, Indhira, Sea Mar Community Health Centers, Seattle, Washington, United States
- Unruh, Mark L., University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
- Prince, David K., University of Washington, Seattle, Washington, United States
Background
In the US, populations who experience kidney health disparities often rely on Community Health Centers (CHCs) for affordable ambulatory care.
Methods
We conducted a retrospective cohort study to examine whether CHC penetration of the state-level low-income population was associated with prevalent kidney disease risk factors, ESKD incidence, process measures reflective of pre-ESKD care quality, and 1-year ESKD survival and kidney transplantation. We studied 318,809 nonelderly adults aged 18-64 years who initiated treatment for ESKD in the US during 2016-2020 and the population characteristics of all 1,370 HRSA CHCs and 51 states for the same time period.
Results
CHC penetration among low-income residents (percentage of low-income residents who were CHC patients in each state) was highest among states in the northeast and lowest among states in the south (mean 35.5% [SD, 19.2%]). The prevalence of diabetes, high blood pressure and obesity were respectively lower in states with high versus low CHC penetration. There were no significant differences in age- and sex-standardized ESKD incidence according to CHC penetration. In individual-level analyses, higher CHC penetration was significantly associated with a higher likelihood of prolonged nephrology care (adjusted OR: 1.04 [95%CI: 1.03-1.05]), arteriovenous fistula or graft usage at hemodialysis initiation (1.11 [1.09-1.12]), home dialysis usage (1.04 [1.02-1.05]), and 1-year kidney transplant (1.09 [1.05-1.12]) and ESKD survival (1.06 [1.04-1.07]). CHC penetration was not associated with the likelihood of pre-emptive kidney transplant (1.00 [0.96-1.04]).
Conclusion
Higher CHC penetration of low-income populations was associated with a lower prevalence of kidney disease risk factors, and better preparedness for, and higher survival after, ESKD onset. These findings warrant additional study into the role and impact of Community Health Centers in addressing longstanding disparities in kidney health.