Community Racial Composition and Hospitalization among Patients Receiving In-center Hemodialysis

Ladan Golestaneh, Kerri L Cavanaugh, Yungtai Lo, Angelo Karaboyas, Michal L Melamed, Tanya S Johns, Keith C Norris
American Journal of Kidney Diseases 2020 July 12

RATIONALE AND OBJECTIVE: Community racial composition has been shown to be associated with mortality in patients with ESKD. It is unclear whether living in communities with predominantly black residents is also associated with risk for hospitalization among patients receiving hemodialysis.

STUDY DESIGN: Retrospective analysis of prospectively collected data from a cohort of patients on hemodialysis.

SETTING AND PARTICIPANTS: 4567 patients treated in 154 dialysis facilities located in 127 unique zip codes and enrolled in United States Dialysis Outcomes and Practice Patterns Study (US-DOPPS), phases 4-5 (2010-2015).

EXPOSURE: Tertile of percent black residents within patients' dialysis facility's zip code defined through a link to the American Community Survey.

OUTCOME: Rate of hospitalizations during the study period.

ANALYTIC APPROACH: The associations of patient-, facility- and community-level variables with percent black residents were assessed using ANOVA, Kruskal Wallis or Chi-square/Fisher exact tests. Negative binomial regression was used to estimate the incidence rate ratio (IRR) for hospitalizations between these communities, with and without adjustment for potential confounding variables.

RESULTS: The mean age of study patients was 62.7 years. Fifty three percent were white, 27% were black and 45% were female. Patients receiving dialysis in facility zip codes with a higher (Tertile 3: ≥14.4%; median 34.2%) versus lower (Tertile 1: ≤1.8%; median 1%) percentage of black residents were more likely to be younger, black, live in urban communities with lower socio-economic status, have a catheter as a vascular access, and have fewer comorbidities. Patients dialyzing in communities with the highest tertile of black residents experienced a higher adjusted rate of hospitalization (adjusted incident rate ratio 1.32, 95% Confidence Interval (1.12-1.56), compared to communities within the lowest tertile.

LIMITATIONS: Potential residual confounding CONCLUSIONS: The risk of hospitalization for patients with ESKD is higher among those treated in communities with a higher percentage of black residents after adjustment for dialysis care as well as patient demographics and comorbidities. Understanding the cause of this association should be a priority of future investigation.

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