Hall Yoshio N, Bensken Wyatt P, Morrissey Suzanne E, De La Cruz Alcantara Indhira, Unruh Mark L, Prince David K
Kidney Research Institute, University of Washington, Seattle, Washington.
VA Puget Sound Health Care System, Seattle, Washington.
Clin J Am Soc Nephrol. 2024 Nov 25;20(2):169-77. doi: 10.2215/CJN.0000000598.
Populations who experience health disparities often rely on community health centers (CHCs) for ambulatory care. Among low-income populations, higher CHC penetration is associated with greater preparedness for, and better outcomes after, kidney failure onset. Our study suggests that CHCs provide essential ambulatory care for nonelderly adults who experience kidney health disparities.
In the United States, historically minoritized populations experience disproportionately high incidence of progressive kidney disease but are often unprepared for kidney failure. Owing to limited options for health care, many minoritized patients with kidney disease rely on community health centers (CHCs) for affordable ambulatory care.
We conducted a retrospective cohort study of 139,275 adults aged 18–64 years who were enrolled in Medicaid or uninsured at the time of ESKD onset during 2016–2020. We examined whether CHC penetration of the state-level low-income population was associated with ESKD incidence, process measures reflective of pre-ESKD care quality, and survival and kidney transplant waitlisting 1 year after ESKD onset. We obtained population characteristics of the 1370 Health Resources and Services Administration CHCs and 50 states (and DC) for the same period.
Mean CHC penetration among low-income residents (percentage of low-income residents who were CHC patients in each state) was 36% (SD, 19%). The Northeast (census region) had the highest proportion of states with high CHC penetration, and the South had the highest proportion of states with low CHC penetration. The prevalence of diabetes mellitus, high BP, and obesity were lower in states with high versus low CHC penetration. There were no significant differences in age- and sex-standardized ESKD incidence according to CHC penetration. In individual-level analyses, higher CHC penetration was significantly associated with a higher likelihood of prolonged nephrology care (adjusted odds ratio [OR], 1.04 [95% confidence interval (CI), 1.03 to 1.05]), arteriovenous fistula or graft usage at hemodialysis initiation (OR, 1.11 [95% CI, 1.09 to 1.12]), home dialysis usage (OR, 1.04 [95% CI, 1.02 to 1.05]), and 1-year kidney transplant waitlisting (OR, 1.19 [95% CI, 1.18 to 1.21]) and ESKD survival (OR, 1.06 [95% CI, 1.04 to 1.07]).
Among Medicaid enrollees and uninsured adults with incident kidney failure, higher CHC penetration was associated with a lower prevalence of kidney disease risk factors and better preparedness for, and higher survival after, ESKD onset. These findings warrant additional study into the role and effect of CHCs in addressing long-standing disparities in kidney health.
经历健康差异的人群通常依赖社区卫生中心（CHC）提供门诊护理。在低收入人群中，CHC渗透率较高与肾衰竭发病前的更好准备以及发病后的更好结果相关。我们的研究表明，CHC为经历肾脏健康差异的非老年成年人提供基本的门诊护理。
在美国，历史上被边缘化的人群患进展性肾病的发病率高得不成比例，但往往对肾衰竭没有做好准备。由于医疗保健选择有限，许多患有肾病的边缘化患者依靠社区卫生中心（CHC）提供负担得起的门诊护理。
我们对2016 - 2020年期间终末期肾病（ESKD）发病时参加医疗补助计划或未参保的139,275名18 - 64岁成年人进行了一项回顾性队列研究。我们研究了州一级低收入人群的CHC渗透率是否与ESKD发病率、反映ESKD发病前护理质量的过程指标、ESKD发病1年后的生存率以及肾脏移植等待名单相关。我们获取了同期1370家卫生资源与服务管理局的CHC以及50个州（和哥伦比亚特区）的人口特征。
低收入居民中的CHC平均渗透率（每个州中作为CHC患者的低收入居民百分比）为36%（标准差，19%）。东北部（普查区域）CHC渗透率高的州所占比例最高，南部CHC渗透率低的州所占比例最高。CHC渗透率高的州与低的州相比糖尿病、高血压和肥胖的患病率较低。根据CHC渗透率，年龄和性别标准化的ESKD发病率没有显著差异。在个体层面分析中，较高的CHC渗透率与延长肾病护理的可能性显著相关（调整后的优势比[OR]，1.04[95%置信区间（CI），1.03至1.05]）、血液透析开始时动静脉内瘘或移植物的使用（OR，1.11[95%CI，1.09至1.12]）、家庭透析的使用（OR，1.04[95%CI，1.02至1.05]）、1年肾脏移植等待名单（OR，1.19[95%CI，1.18至1.21]）以及ESKD生存率（OR，1.
