Table 2.
Association between patient and neighborhood-level characteristics, including sex/gender, and preemptive referral among patients initiating KRT from 2015 to 2019, with follow-up through 2020
| Characteristics | Preemptively referred | Not preemptively referred | Odds ratio (OR) reporting the association between each characteristic and preemptive referral |
|
|---|---|---|---|---|
| Crude OR (95%CI) | Adjusted OR (95% CI)a | |||
| N (%) | 7841 (17.7) | 36,363 (82.3) | ||
| Patient-level characteristics | ||||
| Sex/gender | ||||
| Men | 4371 (55.8) | 20,214 (55.6) | reference | reference |
| Women | 3470 (44.3) | 16,149 (44.4) | 0.99 (0.95–1.04) | 1.09 (1.03–1.15) |
| Age | ||||
| 18–29 | 316 (4.0) | 981 (2.7) | reference | reference |
| 30–39 | 721 (9.2) | 2232 (6.1) | 1.00 (0.86–1.17) | 1.19 (0.99–1.42) |
| 40–49 | 1383 (17.6) | 4570 (12.6) | 0.94 (0.82–1.08) | 1.10 (0.93–1.30) |
| 50–59 | 2053 (26.2) | 8092 (22.3) | 0.79 (0.69–0.90) | 0.93 (0.79–1.10) |
| 60–69 | 2431 (31.0) | 11,056 (30.4) | 0.68 (0.60–0.78) | 0.82 (0.69–0.96) |
| 70–79 | 937 (12.0) | 9432 (25.9) | 0.31 (0.27–0.36) | 0.36 (0.30–0.43) |
| Race/ethnicity group | ||||
| White | 3768 (48.1) | 14,704 (40.4) | reference | reference |
| Black | 3643 (46.5) | 19,705 (54.2) | 0.72 (0.69–0.76) | 0.84 (0.78–0.89) |
| Hispanic | 184 (2.4) | 1171 (3.2) | 0.61 (0.52–0.72) | 0.63 (0.53–0.76) |
| Other | 246 (3.1) | 783 (2.2) | 1.23 (1.06–1.42) | 1.08 (0.91–1.28) |
| Insurance status | ||||
| Medicaid | 1157 (14.8) | 8446 (23.2) | 0.25 (0.23–0.27) | 0.39 (0.36–0.43) |
| Medicare | 2546 (32.5) | 15,113 (41.6) | 0.31 (0.29–0.33) | 0.57 (0.53–0.62) |
| Employer | 3189 (40.7) | 5787 (15.9) | reference | reference |
| Other | 732 (9.3) | 2977 (8.2) | 0.45 (0.41–0.49) | 0.57 (0.53–0.62) |
| None | 217 (2.8) | 4040 (11.1) | 0.10 (0.08–0.11) | 0.12 (0.10–0.14) |
| Attributed cause of kidney failure | ||||
| Diabetes | 3174 (41.2) | 17,002 (47.4) | reference | reference |
| Hypertension | 2275 (29.6) | 13,177 (36.8) | 0.93 (0.87–0.98) | 0.89 (0.83–0.96) |
| Glomerulonephritis | 1045 (13.6) | 2216 (6.2) | 2.53 (2.33–2.74) | 1.47 (1.31–1.64) |
| Other | 1206 (15.7) | 3453 (9.6) | 1.87 (1.73–2.02) | 1.14 (1.02–1.26) |
| Obesity (BMI, kg/m2) | ||||
| Underweight | 126 (1.6) | 1092 (3.0) | 0.59 (0.49–0.72) | 0.58 (0.47–0.73) |
| Normal | 1,733 (22.2) | 8872 (24.5) | reference | reference |
| Overweight | 2374 (30.4) | 9544 (26.4) | 1.27 (1.19–1.36) | 1.22 (1.13–1.32) |
| Obese class I | 1928 (24.7) | 7333 (20.3) | 1.35 (1.25–1.45) | 1.27 (1.17–1.38) |
| Obese class II | 1067 (13.7) | 4479 (12.4) | 1.22 (1.12–1.33) | 1.14 (1.03–1.25) |
| Obese class III | 588 (7.5) | 4879 (13.5) | 0.62 (0.56–0.68) | 0.58 (0.52–0.65) |
| Comorbidities | ||||
| Congestive heart failure | 1019 (13.0) | 10,604 (29.2) | 0.36 (0.34–0.39) | 0.53 (0.49–0.57) |
| Atherosclerotic heart disease | 445 (5.7) | 3292 (9.1) | 0.60 (0.55–0.67) | 1.04 (0.93–1.17) |
| Other cardiac disease | 904 (11.5) | 6579 (18.1) | 0.59 (0.55–0.64) | 0.85 (0.78–0.92) |
| Cerebrovascular disease | 395 (5.0) | 3612 (9.9) | 0.48 (0.43–0.54) | 0.66 (0.59–0.74) |
| Peripheral vascular disease | 336 (4.3) | 2971 (8.2) | 0.50 (0.45–0.57) | 0.78 (0.69–0.89) |
| Hypertension | 7097 (90.5) | 32,773 (90.1) | 1.04 (0.96–1.14) | 1.35 (1.22–1.50) |
| Diabetes | 4129 (52.7) | 22,709 (62.5) | 0.67 (0.64–0.70) | 0.89 (0.83–0.96) |
| COPD | 246 (3.1) | 3450 (9.5) | 0.31 (0.27–0.35) | 0.56 (0.48–0.65) |
| Cancer | 299 (3.8) | 2117 (5.8) | 0.64 (0.57–0.73) | 0.70 (0.61–0.80) |
| Tobacco Use | 364 (4.6) | 3491 (9.6) | 0.46 (0.41–0.51) | 0.61 (0.54–0.69) |
| Pre-KRT nephrology care (reference = yes) | 6877 (95.1) | 23,619 (75.7) | 0.16 (0.15–0.18) | n/ab |
| Patient has been informed of kidney transplant options (reference = yes) | 6587 (95.4) | 33,274 (91.5) | 0.52 (0.46–0.58) | 0.62 (0.55–0.70) |
| Neighborhood-level factors | ||||
| Neighborhood poverty level | ||||
| < 20% (low poverty) | 5399 (69.9) | 20,622 (57.5) | reference | reference |
| ≥ 20% (high poverty) | 2326 (30.1) | 15,244 (42.5) | 0.58 (0.55–0.61) | 0.88 (0.81–0.94) |
| Average % Black (per 10% increase) | 30.9 ± 23.3 | 34.8 ± 23.7 | 0.93 (0.92–0.94) | 0.98 (0.97–1.00) |
| Average % high school graduates (per 10% increase) | 86.8 ± 6.7 | 84.8 ± 6.7 | 1.59 (1.53–1.66) | 1.29 (1.23–1.36) |
BMI, body mass index; CI, confidence interval; COPD, chronic obstructive pulmonary disease; KRT, kidney replacement therapy; OR, odds ratio.
Values are presented as n (%) and mean ± SD.
a
Multivariable model adjusted for all characteristics in Table 2, excluding pre-KRT nephrology care; 5.2% missing data and excluded from multivariable model.
b
Pre-KRT nephrology care not included in multivariable models.