Table 3.
Associations of each state-level factor and receipt of nephrologist care at least 12 months before ESRD, controlling for patient-level factors, separately for each of the four race–age subpopulations
| State-Level Factor | Age <65 yr | Age ≥65 yr | ||||||
|---|---|---|---|---|---|---|---|---|
| Black | White | Black | White | |||||
| OR (95% CI) | P Value | OR (95% CI) | P Value | OR (95% CI) | P Value | OR (95% CI) | P Value | |
| General healthcare access, % or score per 1 SD | ||||||||
| Uninsured persons aged 18–64 yr (per 5%) | 0.81 (0.73 to 0.91) | <0.001 | 0.84 (0.76 to 0.92) | <0.001 | 0.83 (0.73 to 0.94) | 0.004 | 0.94 (0.85 to 1.03) | 0.19 |
| State Medicaid eligibility score | 1.10 (0.99 to 1.24) | 0.09 | 1.11 (1.01 to 1.22) | 0.02 | 1.07 (0.94 to 1.21) | 0.31 | 1.05 (0.96 to 1.14) | 0.28 |
| State Medicaid services score | 1.07 (0.96 to 1.20) | 0.22 | 1.07 (0.98 to 1.18) | 0.14 | 1.06 (0.93 to 1.20) | 0.40 | 1.03 (0.95 to 1.13) | 0.46 |
| State Medicaid quality of care score | 1.06 (0.95 to 1.18) | 0.32 | 1.03 (0.94 to 1.14) | 0.48 | 1.04 (0.92 to 1.18) | 0.54 | 1.01 (0.93 to 1.11) | 0.78 |
| State Medicaid reimbursement score | 1.14 (1.02 to 1.27) | 0.02 | 1.06 (0.96 to 1.16) | 0.24 | 1.15 (1.02 to 1.30) | 0.02 | 1.06 (0.97 to 1.16) | 0.21 |
| Preventive care, % | ||||||||
| Aged >50 yr receiving recommended screening and preventive care (per 5%) | 1.22 (1.10 to 1.36) | <0.001 | 1.21 (1.11 to 1.32) | <0.001 | 1.22 (1.09 to 1.36) | <0.001 | 1.19 (1.10 to 1.28) | <0.001 |
| Socioeconomic status, % | ||||||||
| Aged >25 yr who did not complete high school (per 5%) | 0.82 (0.72 to 0.92) | 0.001 | 0.83 (0.75 to 0.91) | <0.001 | 0.78 (0.68 to 0.89) | <0.001 | 0.83 (0.76 to 0.91) | <0.001 |
| Persons in poverty (per 5%) | 0.85 (0.72 to 1.00) | 0.05 | 0.86 (0.74 to 0.99) | 0.04 | 0.79 (0.66 to 0.95) | 0.01 | 0.85 (0.74 to 0.97) | 0.01 |
| Black residents (per 10%) | 0.88 (0.80 to 0.96) | 0.006 | 0.93 (0.85 to 1.01) | 0.08 | 0.88 (0.80 to 0.98) | 0.02 | 0.89 (0.83 to 0.97) | 0.01 |
| Minority residents (per 10%) | 0.87 (0.80 to 0.95) | 0.001 | 0.94 (0.88 to 1.00) | 0.07 | 0.89 (0.81 to 0.98) | 0.01 | 0.93 (0.87 to 0.99) | 0.02 |
| Healthcare resources | ||||||||
| Primary care physicians (no. per 10,000 population) (per 1 physician) | 0.99 (0.94 to 1.04) | 0.72 | 1.04 (1.00 to 1.09) | 0.07 | 0.98 (0.93 to 1.04) | 0.51 | 1.00 (0.96 to 1.05) | 0.92 |
| Nephrologists (no. per million population) (per 1 nephrologist) | 0.99 (0.99 to 1.00) | 0.14 | 1.00 (0.99 to 1.01) | 0.54 | 0.99 (0.98 to 1.00) | 0.08 | 0.99 (0.98 to 1.00) | 0.02 |
| Geographic properties, % | ||||||||
| Population density (natural log of persons per square mile) (per 1 unit) | 0.94 (0.87 to 1.03) | 0.17 | 0.97 (0.91 to 1.04) | 0.40 | 0.95 (0.86 to 1.05) | 0.31 | 0.96 (0.90 to 1.02) | 0.18 |
| Urban population (per 10%) | 0.92 (0.85 to 0.99) | 0.03 | 0.95 (0.89 to 1.01) | 0.11 | 0.98 (0.90 to 1.08) | 0.73 | 0.96 (0.90 to 1.02) | 0.15 |
| Farmland use (per 20%) | 0.99 (0.90 to 1.10) | 0.92 | 0.98 (0.91 to 1.05) | 0.52 | 1.01 (0.91 to 1.13) | 0.84 | 0.99 (0.92 to 1.06) | 0.67 |
Results for each subpopulation were obtained separately. ORs and P values for each state-level factor were obtained individually (model 3), controlling for patient factors including age, sex, employment, lifestyle behaviors (smoking, alcohol, and drug dependence), and physical/functional conditions, presence of each comorbid condition (hypertension, diabetes, cardiac failure, atherosclerotic heart disease, other heart disease, cerebrovascular disease, peripheral vascular disease, chronic obstructive pulmonary disease, cancer, amputation). Presented ORs are the ORs associated with the unit(s) increase as indicated for each of the factors. OR, odds ratio; 95% CI, 95% confidence interval.