Kidney Week

Abstract: TH-PO1008

Health Insurance Status since the Affordable Care Act among US Adults with and without CKD

Session Information

• CKD: Epidemiology, Risk Factors, and Prevention - 1
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Kiryakos, Jenna, University of Michigan Department of Internal Medicine, Ann Arbor, Michigan, United States

Jenna Kiryakos, MPH

• Veinot, Tiffany C., University of Michigan School of Information, Ann Arbor, Michigan, United States

Tiffany C. Veinot, PhD

• Han, Yun, University of Michigan Department of Internal Medicine, Ann Arbor, Michigan, United States

Yun Han, MS, PhD

• Herman, William H., University of Michigan Department of Internal Medicine, Ann Arbor, Michigan, United States

William H. Herman, MD, MPH

• Morgenstern, Hal, University of Michigan School of Public Health, Ann Arbor, Michigan, United States

Hal Morgenstern, PhD

• Miyamoto, Yoshihisa, Centers for Disease Control and Prevention, Atlanta, Georgia, United States

Yoshihisa Miyamoto, MD, PhD

• Saran, Rajiv, University of Michigan Department of Internal Medicine, Ann Arbor, Michigan, United States

Rajiv Saran, MD, MBBS, MS

• Bragg-Gresham, Jennifer L., University of Michigan Department of Internal Medicine, Ann Arbor, Michigan, United States

Jennifer L. Bragg-Gresham, PhD

Background

Adults without health insurance are more likely to delay care due to costs, including preventive care and services for acute and chronic illnesses. In 2010, the Affordable Care Act (ACA) was implemented to reduce the number of uninsured individuals under age 65 through health insurance exchanges, the dependent coverage provision, Medicaid expansion, and other policy changes. As health care coverage is important for optimal management of chronic kidney disease (CKD), we sought to examine the proportion of adults who lack health care coverage by CKD status.

Methods

We included 38,119 participants from the National Health and Nutrition Examination Survey (NHANES, 2001–March 2020) aged 18–64 years. CKD was defined by the presence of albuminuria (urine albumin to creatinine ratio – UACR ≥30 mg/g) or estimated glomerular filtration rate (eGFR) <60 ml/min/1.73m². Lack of health care coverage was defined by a response of “No” to the NHANES question “Are you covered by health insurance or some other kind of health care plan?”. The proportion of adults without health insurance by CKD status was age-standardized to the 2010 U.S. Census population for adults ages 18–24, 25–44, and 45–64.

Results

The sample included 3,967 participants with CKD and 34,152 participants without CKD. The mean age of the entire sample was 40.7 and 50% were male. For both those with and without CKD, prevalence of lack of health insurance increased from 2001-2004 to 2009-2012 (p=0.01), then declined (p<0.001). The decline corresponded with the implementation of the ACA (Figure). Age-standardized trends were similar to crude rates.

Conclusion

Since 2009-2012, coinciding with the ACA implementation, there has been a decrease in the proportion of US adults without health insurance. This trend was present in adults with or without CKD; however, the percentage of persons lacking health insurance tended to be higher among those with CKD.

Funding

• Other U.S. Government Support