Neighborhood Socioeconomic Status and Quality of Kidney Care: Data from Electronic Health Records

Abstract Rational & Objective Electronic health records can be leveraged to assess quality of care measures in chronic kidney disease (CKD) patients. Neighborhood socioeconomic status could be a potential barrier to receiving appropriate evidence-based therapy and follow up. We examined whether neighborhood socioeconomic status is independently associated with quality of care received by CKD patients. Study Design Observational study using electronic health records data Setting & Participants Retrospective study of patients seen at a healthcare system in the 7-county Minneapolis/St Paul area. Exposures Census tract socioeconomic status measures (wealth, income, education) Outcomes Indicators of CKD quality of care: 1) prescription for angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACEi/ARB) in patients with ≥stage 3 CKD, or stage 1 or 2 CKD with urine albumin to creatinine ratio (UACR)>300mg/day; 2) UACR measurement among patients with lab-based CKD (estimated glomerular filtration rate Analytic Approach Multilevel Poisson regression with robust error variance with a random intercept at the census tract level Results Of the 16,776 patients who should be on ACEi/ARB, 65% were prescribed these medications. Among patients with lab-based CKD (n=25,097), UACR was measured in 27% and CKD was identified in the EHR in 55%. We found no independent association between any neighborhood socioeconomic status measures and CKD quality of care indicators. Limitation One healthcare system and selection bias Conclusions We found no association of neighborhood socioeconomic status with quality of CKD care in our cohort. However, adherence to CKD guidelines is low, indicating an opportunity to improve care for all patients, regardless of neighborhood socioeconomic status.