Sociodemographic and Geographic Predictors of Quality of Care in United States Patients With End-Stage Renal Disease Due to Lupus Nephritis

• Type of Material: Article
• Authors: Laura Plantinga, Emory University; Cristina Drenkard, Emory University; Rachel Patzer, Emory University; Mitchel Klein, Emory University; Michael Kramer, Emory University; Stephen Pastan, Emory University; Sung Lim, Emory University; William M. McClellan, Emory University
• Language: English
• Date: 2015-03
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 by the American College of Rheumatology.
• Final Published Version (URL): http://dx.doi.org/10.1002/art.38983
• Title of Journal or Parent Work: Arthritis and Rheumatology
• ISSN: 2326-5191
• Volume: 67
• Issue: 3
• Start Page: 761
• End Page: 772
• Grant/Funding Information: Supported in part by the NIH (grant R01-AR-065493 to Drs. Drenkard and Lim, National Center for Advancing Translational Sciences grants ULl-TR-000454 and KL2-TR-000455 to Dr. Patzer, National Institute on Minority Health and Health Disparities grant 1R24-MD-008077-01 to Drs. Patzer and Pastan, and Eunice Kennedy Shriver National Institute of Child Health and Human Development grant K01-HD-074726 to Dr. Kramer) and by the CDC (grant U01-DP-005119 to Drs. Drenkard and Lin).; Dr. Plantinga’s work was supported by the Laney Graduate School, Emory University.
• Keywords: PRE-ESRD CARE; Life Sciences & Biomedicine; KIDNEY-TRANSPLANTATION; DIALYSIS PATIENTS; Rheumatology; Science & Technology; HEMODIALYSIS VASCULAR ACCESS; NEPHROLOGIST; MORTALITY; VARIABILITY; RACE; PROPENSITY SCORE ANALYSIS; OUTCOMES
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

Objective: To describe end-stage renal disease (ESRD) quality of care (receipt of pre-ESRD nephrology care, access to kidney transplantation, and placement of permanent vascular access for dialysis) in US patients with ESRD due to lupus nephritis (LN-ESRD) and to examine whether quality measures differ by patient sociodemographic characteristics or US region. Methods: National surveillance data on patients in the US in whom treatment for LN-ESRD was initiated between July 2005 and September 2011 (n = 6,594) were analyzed. Odds ratios (ORs) and hazard ratios (HRs) with 95% confidence intervals (95% CIs) were determined for each quality measure, according to sociodemographic factors and US region. Results: Overall, 71% of the patients received nephrology care prior to ESRD. Black and Hispanic patients were less likely than white patients to receive pre-ESRD care (OR 0.73 [95% CI 0.63-0.85] and OR 0.73 [95% CI 0.60-0.88], respectively) and to be placed on the kidney transplant waitlist within the first year after the start of ESRD (HR 0.78 [95% CI 0.68-0.91] and HR 0.82 [95% CI 0.68-0.98], respectively). Those with Medicaid (HR 0.51 [95% CI 0.44-0.58]) or no insurance (HR 0.36 [95% CI 0.29-0.44]) were less likely than those with private insurance to be placed on the waitlist. Only 24% had a permanent vascular access, and placement was even less likely among the uninsured (OR 0.62 [95% CI 0.49-0.79]). ESRD quality-of-care measures varied 2-3-fold across regions of the US, with patients in the Northeast and Northwest generally having higher probabilities of adequate care. Conclusion: LN-ESRD patients have suboptimal ESRD care, particularly with regard to placement of dialysis vascular access. Minority race/ethnicity and lack of private insurance are associated with inadequate ESRD care. Further studies are warranted to examine multilevel barriers to, and develop targeted interventions to improve delivery of, care among patients with LN-ESRD.