1
|
West J, Chan HK, Wang H, Molony D, Foringer J, Huebinger R, Robinson D, Chavez S. Emergency department visits for hemodialysis by insurance status in the United States. J Am Coll Emerg Physicians Open 2022; 3:e12698. [PMID: 35462963 PMCID: PMC9019139 DOI: 10.1002/emp2.12698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/13/2022] [Accepted: 02/17/2022] [Indexed: 11/25/2022] Open
Abstract
Objective Many uninsured patients with end‐stage kidney disease (ESKD) depend upon the emergency department (ED) for hemodialysis (HD). We sought to characterize ED visits for emergent HD by insurance status. Methods We performed a cross‐sectional analysis of the 2017 Nationwide Emergency Department Sample, including ED visits by patients ≥18 years old with a length of stay ≤1 day and performance of HD. Insurance status determined by “insured” as Medicare, Medicaid, or commercial and “uninsured” as self‐pay or charity. Results Of 118,034,396 adult ED visits, 235,988 were associated with HD: uninsured 62,503 (incidence 5.30 per 10,000, 95% confidence interval [CI]: 5.26–5.34) and insured 172,889 (incidence 14.65 per 10,000, 95% CI: 14.60–14.74). The south census region accounted for 89% of uninsured ED HD (odds ratio [OR] 31.55, 95% CI: 8.97–110.97). Compared to insured patients, uninsured ED HD patients were more likely to be younger (age 18–44, 37.6% vs 19.9%). The most common primary diagnosis for uninsured and insured ED HD patients was hypertensive chronic kidney disease (34.6% and 26.2%, respectively). Uninsured ED HD patients were less likely to be admitted (3.4% vs 36.0%, OR 0.06, 95% CI: 0.02–0.20). Most ED HD patients were discharged home (95.2% uninsured vs 57.6% insured). ED charges per visit were $5,992.32 for uninsured and $10,985.87 for insured ED HD patients. Conclusions Our findings highlight the health care burden of ED HD. Novel system approaches are needed for the management of uninsured and insured patients with ESKD.
Collapse
Affiliation(s)
- Julianna West
- McGovern Medical School The University of Texas Health Science Center at Houston Houston Texas USA
| | - Hei Kit Chan
- Department of Biostatistics School of Public Health The University of Texas Health Science Center at Houston Houston Texas USA
| | - Henry Wang
- Department of Emergency Medicine The Ohio State University Houston Ohio USA
| | - Donald Molony
- Department of Renal Diseases and Hypertension The University of Texas Health Science Center at Houston Houston Texas USA
| | - John Foringer
- Department of Renal Diseases and Hypertension The University of Texas Health Science Center at Houston Houston Texas USA
| | - Ryan Huebinger
- Department of Emergency Medicine The University of Texas Health Science Center at Houston Houston Texas USA
| | - David Robinson
- Department of Emergency Medicine The University of Texas Health Science Center at Houston Houston Texas USA
| | - Summer Chavez
- Department of Emergency Medicine The University of Texas Health Science Center at Houston Houston Texas USA
| |
Collapse
|
2
|
Eneanya ND, Tiako MJN, Novick TK, Norton JM, Cervantes L. Disparities in Mental Health and Well-Being Among Black and Latinx Patients With Kidney Disease. Semin Nephrol 2022; 41:563-573. [PMID: 34973700 DOI: 10.1016/j.semnephrol.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Black and Latinx individuals in the United States are afflicted disproportionately with kidney disease. Because of structural racism, social risk factors drive disparities in disease prevalence and result in worse outcomes among these patient groups. The impact of social and economic oppression is pervasive in physical and emotional aspects of health. In this review, we describe the history of race and ethnicity among black and Latinx individuals in the United States and discuss how these politicosocial constructs impact disparities in well-being and mental health. Lastly, we outline future research, clinical considerations, and policy considerations to eliminate racial and ethnic disparities in well-being among black and Latinx individuals with kidney disease.
Collapse
Affiliation(s)
- Nwamaka D Eneanya
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | | | - Tessa K Novick
- Division of Nephrology, Department of Internal Medicine, University of Texas, Austin Dell Medical School, Austin, TX
| | - Jenna M Norton
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Lilia Cervantes
- Division of Hospital Medicine, Department of Medicine, University of Colorado, Aurora, CO
| |
Collapse
|
3
|
Shin SM, Lee HW. Disease Burden of the Kidney Disabled in Korea, 2009-2013: The Gap with That of the Non-Kidney Disabled Continues. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:249. [PMID: 35010517 PMCID: PMC8751061 DOI: 10.3390/ijerph19010249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/19/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
Kidney disability due to kidney failure could be considered to be the most severe of all the internal-organ disabilities. The purpose of this study was to identify the disease burden between the kidney and non-kidney disabled among the internal-organ disabled, based on the number of chronic diseases, annual out-of-pocket expenditure, and quality of life. From 2009 to 2013, 308 people (6.5%) with internal-organ disabilities were extracted out of 4732 people with disabilities in the Korea Health Panel. We compared the disease burden of 136 people with kidney disability (44.2%) and 172 people with non-kidney disability (55.8%), and confirmed the trend of disease burden over five years through panel analysis. The disease burden gap between kidney and non-kidney disabilities was, respectively, the number of chronic diseases (4.7 vs. 3.3, p < 0.0001), annual out-of-pocket expenditure ($1292 vs. $847, p < 0.004), and quality of life score out of 100 (49.2 vs. 60.2, p < 0.0001). In addition, when looking at the five-year trend of the three disease burden indexes, the kidney disabled were consistently worse than the non-kidney disabled (p < 0.01). In conclusion, health policy planners aiming for health equity need to seek practical strategies to reduce the gap in the disease burden among people with disabilities.
Collapse
Affiliation(s)
- Sun-Mi Shin
- Department of Nursing, Joongbu University, 201 Daehak-ro, Chubu-myeon, Chungnam, Geumsan-gun 32713, Korea;
| | - Hee-Woo Lee
- Hemodialysis Unit, Lee Hee Woo Internal Medicine Clinic, 1402 Gyebaek-ro, Seogu, Daejeon 35400, Korea
| |
Collapse
|
4
|
de la Cruz JPS, Morales DLG, González-Castro TB, Tovilla-Zárate CA, Juárez-Rojop IE, López-Narváez L, Hernández-Díaz Y, Ble-Castillo JL, Pérez-Hernández N, Rodriguez-Perez JM. Quality of life of Latin-American individuals with type 2 diabetes mellitus: A systematic review. Prim Care Diabetes 2020; 14:317-334. [PMID: 31564515 DOI: 10.1016/j.pcd.2019.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 09/02/2019] [Accepted: 09/06/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Diabetes mellitus is a serious public health problem that causes a decrease in the patients' quality of life. The present study was aimed to analyze the quality of life of patients with diabetes mellitus in Latin-American population through a systematic review, using the two instruments of greater validity and reliability at international level, SF-36 and WHOQOL. METHODS We performed extensive searches in Redalyc, SciELO, PubMed, Scopus and Web of Science databases. To delimit our search, we only included countries that are members of the Latin American Association of Diabetes. We identified 2168 articles, where 35 were considered relevant for this systematic review. RESULTS Our results showed that patients that regularly receive guidance and treatment to control the diabetes, showed better quality of life; in contrast, patients with foot ulcers or comorbidities showed the worse quality of life. CONCLUSION The current literature analysis suggests that this disease greatly influences in the quality of life of the patients.
Collapse
Affiliation(s)
- Juan Pablo Sánchez de la Cruz
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Comalcalco, Comalcalco, Tabasco, Mexico
| | - Diana Laura González Morales
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Comalcalco, Comalcalco, Tabasco, Mexico
| | - Thelma Beatriz González-Castro
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Jalpa de Méndez, Jalpa de Méndez, Tabasco, Mexico
| | - Carlos Alfonso Tovilla-Zárate
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Comalcalco, Comalcalco, Tabasco, Mexico.
| | - Isela Esther Juárez-Rojop
- Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Villahermosa, Tabasco, Mexico
| | | | - Yazmin Hernández-Díaz
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Jalpa de Méndez, Jalpa de Méndez, Tabasco, Mexico
| | - Jorge Luis Ble-Castillo
- Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Villahermosa, Tabasco, Mexico
| | - Nonancit Pérez-Hernández
- Department of Molecular Biology, National Institute of Cardiology Ignacio Chávez, Mexico City 14080, Mexico
| | | |
Collapse
|
5
|
Berger JR, Quinones H, Vazquez MA. Dialysis for Undocumented Immigrants: Challenges and Solutions. KIDNEY360 2020; 1:549-552. [PMID: 35368606 DOI: 10.34067/kid.0000682020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Joseph R Berger
- Medicine-Nephrology Division, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Henry Quinones
- Medicine-Nephrology Division, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Miguel A Vazquez
- Medicine-Nephrology Division, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
6
|
West J, Chan HK, Molony DA, Robinson DJ, Foringer JR, Wang HE. Insurance Status and Emergency Department Visits Associated With Hemodialysis in Texas. JAMA Netw Open 2020; 3:e1921447. [PMID: 32074286 DOI: 10.1001/jamanetworkopen.2019.21447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Julianna West
- Department of Emergency Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston
| | - Hei Kit Chan
- Department of Emergency Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston
| | - Donald A Molony
- Department of Emergency Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston
| | - David J Robinson
- Department of Emergency Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston
| | - John R Foringer
- Department of Emergency Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston
| | - Henry E Wang
- Department of Emergency Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston
| |
Collapse
|
7
|
Renal Replacement Therapy for Undocumented Immigrants: Current Models with Medical, Financial, and Physician Perspectives-a Narrative Review. J Gen Intern Med 2019; 34:2246-2253. [PMID: 31388913 PMCID: PMC6816691 DOI: 10.1007/s11606-019-05237-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/12/2018] [Accepted: 07/15/2019] [Indexed: 10/26/2022]
Abstract
Renal replacement therapy is guaranteed for all US citizens with end-stage renal disease (ESRD). Undocumented immigrants with ESRD are a particularly vulnerable subset of renal failure patients. There is no federal legislation for these patients except for the requirement to treat them during "emergency medical conditions" and federal legislation excluding them from the guarantee of renal replacement therapy described above. Different states have developed different methods for dealing with this problem, with variation in management even addressed on a center by center basis. This review of the original studies published in the literature reveals the medical, ethical, and financial problems with this situation. These patients frequently have delayed presentation to care, poor access to routine care, increased complications, increased utilization of services, and increased morbidity and mortality in an emergent dialysis model compared to chronic outpatient care. They present an ethical dilemma for practitioners who know they are providing substandard care and occasionally making decisions on how to allocate resources. Emergent dialysis is associated with inadequate reimbursement, increased threat to sustained unemployment, and an overburdening of our healthcare infrastructure. This practice puts patients at risk, places an unfair ethical burden on providers and is financially unsustainable. Special considerations described for kidney transplant and peritoneal dialysis are considered and considerations for a new model are reviewed in the paper. Ultimately accommodations must be made with the input of government, healthcare practitioners, and facilities needs to be reached to protect these vulnerable patients.
Collapse
|
8
|
Seto Nielsen L, Goldstein Z, Leung D, Lee C, Buick C. A Scoping Review of Undocumented Immigrants and Palliative Care: Implications for the Canadian Context. J Immigr Minor Health 2019; 21:1394-1405. [DOI: 10.1007/s10903-019-00882-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
9
|
Nguyen OK, Vazquez MA, Charles L, Berger JR, Quiñones H, Fuquay R, Sanders JM, Kapinos KA, Halm EA, Makam AN. Association of Scheduled vs Emergency-Only Dialysis With Health Outcomes and Costs in Undocumented Immigrants With End-stage Renal Disease. JAMA Intern Med 2019; 179:175-183. [PMID: 30575859 PMCID: PMC6439652 DOI: 10.1001/jamainternmed.2018.5866] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE In 40 of 50 US states, scheduled dialysis is withheld from undocumented immigrants with end-stage renal disease (ESRD); instead, they receive intermittent emergency-only dialysis to treat life-threatening manifestations of ESRD. However, the comparative effectiveness of scheduled dialysis vs emergency-only dialysis and the influence of treatment on health outcomes, utilization, and costs is uncertain. OBJECTIVE To compare the effectiveness of scheduled vs emergency-only dialysis with regard to health outcomes, utilization, and costs in undocumented immigrants with ESRD. DESIGN, SETTING, AND PARTICIPANTS Observational cohort study of 181 eligible adults with ESRD receiving emergency-only dialysis in Dallas, Texas, who became newly eligible and applied for private commercial health insurance in February 2015; 105 received coverage and were enrolled in scheduled dialysis; 76 were not enrolled in insurance for nonclinical reasons (eg, lack of capacity at a participating outpatient dialysis center) and remained uninsured, receiving emergency-only dialysis. We examined data on eligible persons during a 6-month period prior to enrollment (baseline period, August 1, 2014-January 31, 2015) until 12 months after enrollment (follow-up period, March 1, 2015-February 29, 2016), with an intervening 1-month washout period (February 2015). All participants were undocumented immigrants; self-reported data on immigration status was collected from Parkland Hospital electronic health records. EXPOSURES Enrollment in private health insurance coverage and scheduled dialysis. MAIN OUTCOMES AND MEASURES We used enrollment in health insurance and scheduled dialysis to estimate the influence of scheduled dialysis on 1-year mortality, utilization, and health care costs, using a propensity score-adjusted, intention-to-treat approach, including time-to-event analyses for mortality, difference-in-differences (DiD) negative binomial regression analyses for utilization, and DiD gamma generalized linear regression for health care costs. RESULTS Of 181 eligible adults with ESRD, 105 (65 men, 40 women; mean age, 45 years) received scheduled dialysis and 76 (38 men, 38 women; mean age, 52 years) received emergency-only dialysis. Compared with emergency-only dialysis, scheduled dialysis was significantly associated with reduced mortality (3% vs 17%, P = .001; absolute risk reduction, 14%; number needed to treat, 7; adjusted hazard ratio, 4.6; 95% CI, 1.2-18.2; P = .03), adjusted emergency department visits (-5.2 vs +1.1 visits/mo; DiD, -6.2; P < .001), adjusted hospitalizations (-2.1 vs -0.5 hospitalizations/6 months; DiD, -1.6; P < .001), adjusted hospital days (-9.2 vs +0.8 days/6 months; DiD, -9.9; P = .007), and adjusted costs (-$4316 vs +$1452 per person per month; DiD, -$5768; P < .001). CONCLUSIONS AND RELEVANCE In this study, scheduled dialysis was significantly associated with reduced 1-year mortality, health care utilization, and costs compared with emergency-only dialysis. Scheduled dialysis should be the universal standard of care for all individuals with ESRD in the United States.
Collapse
Affiliation(s)
- Oanh Kieu Nguyen
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.,Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas
| | - Miguel A Vazquez
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | | | - Joseph R Berger
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Henry Quiñones
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | | | - Joanne M Sanders
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas
| | | | - Ethan A Halm
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.,Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas
| | - Anil N Makam
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.,Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas
| |
Collapse
|
10
|
Howley L. How Do We Solve Maria's Problem? A Hospitalist Perspective. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:86-87. [PMID: 31307355 DOI: 10.1080/15265161.2018.1544311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
|
11
|
Shen JI, Hercz D, Barba LM, Wilhalme H, Lum EL, Huang E, Reddy U, Salas L, Vangala S, Norris KC. Association of Citizenship Status With Kidney Transplantation in Medicaid Patients. Am J Kidney Dis 2017; 71:182-190. [PMID: 29128413 DOI: 10.1053/j.ajkd.2017.08.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 08/07/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although individuals classified as nonresident aliens, including undocumented immigrants, are entitled to receive emergency dialysis in the United States regardless of their ability to pay, most states do not provide them with subsidized care for maintenance dialysis or kidney transplantation. We explored whether nonresident aliens have similar outcomes to US citizens after receiving kidney transplants covered by Medicaid, a joint federal and state health insurance program. STUDY DESIGN Retrospective observational cohort study. SETTING & PARTICIPANTS All adult Medicaid patients in the US Renal Data System who received their first kidney transplant from 1990 to 2011. PREDICTOR Citizenship status, categorized as US citizen, nonresident alien, or permanent resident. OUTCOME All-cause transplant loss. MEASUREMENTS HRs and 95% CIs estimated by applying Cox proportional hazards frailty models with transplantation center as a random effect. RESULTS Of 10,495 patients, 8,660 (82%) were US citizens, 1,489 (14%) were permanent residents, and 346 (3%) were nonresident aliens, whom we assumed were undocumented immigrants. Nonresident aliens were younger, healthier, receiving dialysis longer, and more likely to have had a living donor. 71% underwent transplantation in California, and 61% underwent transplantation after 2005. Nonresident aliens had a lower unadjusted risk for transplant loss compared with US citizens (HR, 0.48; 95% CI, 0.35-0.65). Results were attenuated but still significant when adjusted for demographics, comorbid conditions, dialysis, and transplant-related factors (HR, 0.67; 95% CI, 0.46-0.94). LIMITATIONS Citizenship status was self-reported, possible residual confounding. CONCLUSIONS Our study suggests that the select group of insured nonresident aliens who undergo transplantation with Medicaid do just as well as US citizens with Medicaid. Policymakers should consider expanding coverage for kidney transplantation in nonresident aliens, including undocumented immigrants, given the associated high-quality outcomes in these patients.
Collapse
Affiliation(s)
- Jenny I Shen
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
| | - Daniel Hercz
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Lilly M Barba
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA; Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Holly Wilhalme
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Erik L Lum
- Division of Nephrology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Edmund Huang
- Division of Nephrology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Uttam Reddy
- Division of Nephrology and Hypertension, University of California Irvine, Orange, CA
| | - Leslie Salas
- Division of Nephrology and Hypertension, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Sitaram Vangala
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Keith C Norris
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA
| |
Collapse
|