28 - Race, Ethnicity, and Socioeconomic Status in Pediatric Chronic Kidney Disease: Exploring the Timing of Diagnosis

Poster Number: 28
Publication Number: 28.2202

Background: The incidence and prevalence of CKD are high in Black and Hispanic children and in adults with lower socioeconomic status (SES). Barriers to healthcare access negatively impacts outcomes.

Objective: To assess whether Black, Hispanic children, and children residing in areas with a high Area Deprivation Index (ADI) had more advanced CKD at index pediatric nephrology visit.

Design/Methods: Retrospective data was abstracted from the EHR for the first ambulatory nephrology visit of all patients under the age of 22 years with CKD Stage 2 to 5 in the Division of Nephrology at Lurie Children’s Hospital from January 1, 2011 to June 30th , 2021. Data on demographics, anthropometry, payor type, diagnosis codes, and laboratory results were collected. Estimation of GFR (eGFR) was based on the creatinine-based “Bedside Schwartz” equation (2009); patients were classified as CKD Stage 2, 3, 4, or 5 if eGFR was 60-90, 30-60, 15-30, < 15 cc/min/1.73m2 respectively.

ADI is a measure of neighborhood-level socioeconomic disadvantage that considers factors such as income, education, employment, and housing quality. Using Maptitude software, we derived census tract from patient addresses in Epic and cross referenced them to the publicly available ADI database. Payor was classified as “public” or "private” or “other/unknown.” Individuals with Foreign National insurance were excluded. The "race" variable included Asian, Black, White, Multiple Race, and others. Individuals were further categorized by ethnicity, distinguishing between Hispanic and non-Hispanic populations.

Results: A total of 713 index patients were seen in the pediatric nephrology clinic with CKD Stage 2, 3, 4, and 5 during the study period. 300 (42%) were female. Median age was 7.2 +/- 6.8 years; 101 patients were Black and 314 were Non-Hispanic White; the median (state rank) ADI score for the study population was 4. Neither race, ethnicity nor ADI were associated with differences in CKD stage at initial presentation to the Nephrology Clinic. Sub-analysis of patients with CKD secondary to a diagnosis of congenital anomalies of the kidney and urinary tract (CAKUT) and non-CAKUT demonstrated similar results.

Conclusion(s): ADI is associated with race, ethnicity and payor category, but not with CKD stage at index visit to our site’s clinic. Despite known barriers to care in Black, Hispanic and patients of lower SES, we did not identify an association with delayed diagnosis in CKD. Further analysis is planned to assess for interaction between race, ethnicity and ADI, as well as an adjusted analysis for potential confounders.