TABLE 1.
Characteristics of dialysis facilities with low, moderate, and high referral for kidney transplantation within 1 y of dialysis start in Georgia, North Carolina, and South Carolina: 2012–2016
| Tertile of transplant referral, median % of patients (range) |
|||||
|---|---|---|---|---|---|
| Selected dialysis facility characteristics | All dialysis facilitiesa | Lowest 21.9 (0–28.6) | Middle 33.9 (28.7–39.9) | Highest 48.3 (39.9–100.0) | P valueb |
| Facilities, n | 690 | 234 | 226 | 230 | |
| Total number of patients, n (%) | 34 857 | 11 871 (34.0) | 12 951 (37.2) | 10 035 (28.8) | |
| Facility incident patient-level characteristics | |||||
| Mean age in years, mean (95% CI) | 59.6 (59.3–59.9) | 60.4 (60.0–60.9) | 59.8 (59.4–60.2) | 58.6 (58.0–59.1) | <.001 |
| Male sex, mean % (95% CI) | 54.9 (54.0–55.7) | 54.7 (53.0–56.3) | 55.5 (54.4–56.6) | 54.5 (53.0–56.1) | .62 |
| Race/ethnicity, mean (95% CI) | |||||
| White, non-Hispanic | 39.3 (37.6–41.1) | 44.2 (41.1–47.3) | 39.2 (36.4–42.1) | 34.5 (31.5–37.5) | <.001 |
| White, Hispanic | 2.0 (1.8–2.3) | 1.7 (1.3–2.1) | 2.1 (1.7–2.4) | 2.4 (1.8–3.0) | .09 |
| Black or African American | 54.6 (52.8–56.4) | 49.5 (46.3–52.6) | 55.1 (52.1–58.1) | 59.1 (56.0–62.3) | <.001 |
| Other race/ethnicity | 1.8 (1.4–2.2) | 1.8 (1.2–2.4) | 1.9 (1.1–2.6) | 1.7 (1.2–2.3) | .96 |
| Attributed cause of ESKD, mean % (95% CI) | |||||
| Diabetes | 43.4 (42.3–44.5) | 43.8 (41.8–45.8) | 44.7 (43.1–46.4) | 41.7 (39.5–44.0) | .10 |
| Hypertension | 36.9 (35.6–38.2) | 34.3 (32.1–36.5) | 36.2 (34.2–38.2) | 40.1 (37.6–42.6) | .001 |
| Glomerulonephritis | 6.1 (5.7–6.5) | 6.6 (5.8–7.4) | 6.1 (5.5–6.8) | 5.6 (4.9–6.4) | .18 |
| Other | 9.2 (8.7–9.7) | 9.9 (9.0–10.8) | 9.2 (8.4–9.9) | 8.6 (7.5–9.6) | .11 |
| Facility % of incident patient clinical and laboratory measures | |||||
| Comorbidities, mean % (95% CI) | |||||
| Obese (BMI ≥ 35 kg/m2) | 25.0 (24.3–25.8) | 25.3 (23.8–26.7) | 25.5 (24.6–26.5) | 24.2 (22.8–25.6) | .33 |
| Congestive heart failure | 27.1 (26.0–28.1) | 29.9 (28.1–31.8) | 26.0 (24.4–27.6) | 25.2 (23.3–27.1) | <.001 |
| Atherosclerotic heart disease | 9.2 (8.4–10.0) | 11.9 (10.4–13.5) | 9.0 (8.2–9.8) | 6.7 (5.6–7.9) | <.001 |
| Other cardiac disease | 16.9 (15.9–17.9) | 21.0 (19.2–22.8) | 15.4 (13.7–17.0) | 14.3 (12.7–15.9) | <.001 |
| Cerebrovascular disease (stroke) | 9.1 (8.6–9.6) | 11.2 (10.2–12.2) | 9.0 (8.2–9.8) | 7.1 (6.3–7.9) | <.001 |
| Peripheral vascular disease | 8.2 (7.6–8.9) | 10.5 (9.2–11.7) | 8.0 (7.0–9.0) | 6.1 (5.2–7.1) | <.001 |
| Hypertension | 89.0 (88.2–89.7) | 88.2 (86.8–89.7) | 89.5 (88.5–90.5) | 89.2 (87.8–90.6) | .36 |
| Diabetes | 59.2 (58.2–60.2) | 60.0 (58.2–61.7) | 59.7 (58.1–61.2) | 58.0 (56.1–59.9) | .24 |
| Chronic obstructive pulmonary disease | 8.9 (8.3–9.5) | 11.0 (9.8–12.3) | 8.9 (8.0–9.8) | 6.8 (5.9–7.7) | <.001 |
| Tobacco use | 8.8 (8.2–9.4) | 10.3 (9.0–11.6) | 8.9 (8.1–9.7) | 7.2 (6.3–8.1) | <.001 |
| Cancer | 6.0 (5.5–6.4) | 7.0 (6.2–7.8) | 5.8 (5.2–6.5) | 5.1 (4.2–6.0) | .003 |
| Facility % of incident patient socioeconomic characteristics | |||||
| Pre-ESKD nephrology care, mean % (95% CI) | 70.7 (69.3–72.1) | 71.4 (69.0–73.8) | 72.9 (70.8–75.0) | 67.9 (65.1–70.7) | .01 |
| Primary health insurance provider, mean % (95% CI) | |||||
| Medicare | 40.3 (39.3–41.3) | 42.1 (40.6–43.7) | 40.6 (39.1–42.0) | 38.1 (36.1–40.1) | .004 |
| Medicaid | 24.0 (23.1–25.0) | 26.1 (24.3–27.9) | 23.8 (22.4–25.1) | 22.2 (20.5–23.8) | .003 |
| Employer group | 17.7 (16.8–18.6) | 14.8 (13.5–16.0) | 18.5 (17.1–19.9) | 19.8 (18.0–21.7) | <.001 |
| Other coverage | 6.2 (5.7–6.6) | 5.7 (5.1–6.4) | 6.2 (5.5–6.9) | 6.6 (5.4–7.7) | .40 |
| No coverage | 9.6 (9.1–10.1) | 8.4 (7.6–9.2) | 9.3 (8.6–10.0) | 11.1 (10.0–12.2) | .002 |
| Facility % of incident patient neighborhood (ZIP code) characteristics | |||||
| Neighborhood poverty (% ZIP code residents below poverty), mean % (95% CI) | |||||
| ≥20% below poverty | 31.1 (29.0–33.1) | 30.9 (27.2–34.6) | 32.2 (28.7–35.8) | 30.1 (26.8–33.4) | .70 |
| Average % black, mean (95% CI) | 34.6 (33.2–36.0) | 29.8 (27.5–32.1) | 34.0 (31.5–36.4) | 40.1 (37.7–42.6) | <.001 |
| Average % high school graduates, mean (95% CI) | 82.8 (82.5–83.2) | 81.6 (81.0–82.2) | 83.1 (82.4–83.7) | 83.8 (83.3–84.4) | <.001 |
| Dialysis facility characteristics | |||||
| For-profit, N (%) | 583 (84.5) | 207 (88.5) | 188 (83.2) | 188 (81.7) | .06 |
| Freestanding facility, N (%) | 682 (98.8) | 230 (98.3) | 224 (99.1) | 228 (99.1) | .67 |
| Facility size (# of patients), N (%) | |||||
| ≤25 | 52 (7.5) | 17 (7.3) | 12 (5.3) | 23 (10.0) | <.001 |
| 26–54 | 248 (35.9) | 87 (37.2) | 63 (27.9) | 98 (42.6) | |
| 55–78 | 163 (23.6) | 48 (20.5) | 58 (25.7) | 57 (24.8) | |
| 79+ | 213 (30.9) | 80 (34.2) | 87 (38.5) | 546 (20.0) | |
| Patient to social worker ratioc | |||||
| Mean (95% CI) | 80.9 (77.6–84.1) | 82.2 (77.1–87.4) | 87.7 (81.6–93.8) | 72.7 (67.1–78.3) | <.001 |
| Quartile, N (%) | |||||
| ≤48:1 (quartile 1) | 155 (22.5) | 46 (19.7) | 41 (18.1) | 68 (29.6) | .07 |
| 48:1–76:1 (quartile 2) | 156 (22.6) | 55 (23.5) | 49 (21.7) | 52 (22.6) | |
| 76:1–108:1 (quartile 3) | 156 (22.6) | 59 (25.2) | 58 (25.7) | 39 (17.0) | |
| ≥108:1 (quartile 4) | 156 (22.6) | 51 (21.8) | 58 (25.7) | 47 (20.4) | |
| Missing | 67 (9.7) | 23 (9.8) | 20 (8.9) | 24 (10.4) | |
BMI, body mass index; CI, confidence interval; ESKD, end-stage kidney disease.
a
2 (0.29%) facilities missing comorbidity information; 3 (0.43%) facilities missing pre-ESKD nephrology care; 3 (0.43%) facilities missing profit status; 3 (0.43%) facilities were missing freestanding (vs hospital-based) status; 14 (2.0%) facilities missing facility size.
b
Across tertiles of referral, by analysis of variance or χ2 test.
c
Number of patients for every 1 social worker. Calculated only among those facilities that have social workers.