Community Health Center penetration and kidney care outcomes among low-income, nonelderly adults with kidney failure

Abstract

Health Centers (CHCs) for affordable ambulatory care. Methods: We conducted a retrospective cohort study of 139,275 adults aged 18-64 years who were enrolled in Medicaid or uninsured at time of end-stage kidney disease (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 one year after ESKD onset. We obtained population characteristics of the 1,370 Health Resources and Services Administration CHCs and 50 states (and the District of Columbia) for the same period. Results: Mean CHC penetration among low-income residents (percentage of low-income residents who were CHC patients in each state) was 36% (standard deviation, 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 blood pressure, 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 intervals [CI]: 1.03, 1.05]), arteriovenous fistula or graft usage at hemodialysis initiation (OR: 1.11 [95% CI: 1.09, 1.12]), home dialysis usage (OR: 1.04 [95% CI: 1.02, 1.05]), and one-year kidney transplant waitlisting (OR: 1.19 [95% CI: 1.18, 1.21]) and ESKD survival (OR: 1.06 [95% CI: 1.04, 1.07]). Conclusions: 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 impact of Community Health Centers in addressing longstanding disparities in kidney health. Copyright © 2024 by the American Society of Nephrology...