Healthcare access barriers for Hispanic pediatric nephrology patients: a KICK study.

Abstract

Background: Hispanics, the fastest growing minority in the USA, suffer from high chronic kidney disease (CKD) burden. Barriers to accessing medical care increase disparities and quality of care for Hispanic children with CKD.

Methods: As a part of the grant-funded "Kidney Initiative in Community Kids" (KICK), the voluntary "Barriers to Care Questionnaire" was distributed to self-identified Hispanic young adult patients (> 18 years of age) or parents (if patient < 18 years of age), between January 2021 to June 2021, in a single urban pediatric nephrology ambulatory clinic site. Survey was available in English and Spanish. Sociodemographic and health data was obtained from the medical record and Area Deprivation Index (ADI) was collected as a surrogate marker for socioeconomic disadvantage.

Results: Of the 179 completed surveys (49% Spanish, 51% English), skills (strategies necessary to navigate the healthcare system) and pragmatic (logistical issues that might delay/prevent utilization) barriers were identified with mean (± standard deviation) scores of 74 (± 26) and 75 (± 21), respectively (100 = no barriers). Spanish-speaking preference families had higher skills barriers (p < 0.001). The mean ADI was 55 ± 20: higher ADI score (more disadvantaged population) correlated with higher total barriers (p = 0.04) and was exacerbated by preferred language (p = 0.003).

Conclusions: Hispanic pediatric patients with kidney disease have significant barriers which may impact their interaction with healthcare. Spanish-speaking families are particularly vulnerable. Prospective studies are necessary to advocate for program and policy changes to reduce racial and ethnic disparities in access to pediatric nephrology care.