ArticleClinical journal of the American Society of Nephrology : CJASN2015
Interstate Variation in Receipt of Nephrologist Care in US Patients Approaching ESRD: Race, Age, and State Characteristics.
Article in Clinical journal of the American Society of Nephrology : CJASN, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed.
- A Microsimulation-Based Approach for Mitigating Societal Bias in Chronic Kidney Disease Data.Medical decision making : an international journal of the Society for Medical Decision Making · 2026Article
- A microsimulation-based framework for mitigating societal bias in primary care data.medRxiv : the preprint server for health sciences · 2025Article
- Racial Equity in Living Donor Kidney Transplant Centers, 2008-2018.JAMA network open · 2023Article
- Article
- The effects of socioeconomic status on major adverse cardiovascular events: a nationwide population-based cohort study.Kidney research and clinical practice · 2023Article
- National Trends in the Association of Race and Ethnicity With Predialysis Nephrology Care in the United States From 2005 to 2015.JAMA network open · 2020Article
- Pre-ESKD Nephrology Care and Employment at the Start of Dialysis.Kidney international reports · 2020Article
- Changes in employment status prior to initiation of maintenance hemodialysis in the USA from 2006 to 2015.Clinical kidney journal · 2020Article
- Exploring Care Attributes of Nephrologists Ranking Favorably on Measures of Value.Journal of the American Society of Nephrology : JASN · 2019Article
- Initiation of maintenance hemodialysis through central venous catheters: study of patients' perceptions based on a structured questionnaire.BMC nephrology · 2019Article
- Article
- Hemodialysis Disparities in African Americans: The Deeply Integrated Concept of Race in the Social Fabric of Our Society.Seminars in dialysis · 2017Review
- Younger black patients have a higher risk of infection mortality that is mostly non-dialysis related: A national study of cause-specific mortality among U.S. maintenance dialysis patients.Hemodialysis international. International Symposium on Home Hemodialysis · 2017Article
- Impact of poverty and race on pre-end-stage renal disease care among dialysis patients in the United States.Clinical kidney journal · 2017Article
- Geographic Variation and US County Characteristics Associated With Rapid Kidney Function Decline.Kidney international reports · 2017Article
- Border Health: State-Level Variation in Predialysis Nephrology Care.Clinical journal of the American Society of Nephrology : CJASN · 2015Article
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8 authors.
Funding
Abstract
BACKGROUND AND
objectivesAlthough multiple factors influence access to nephrologist care in patients with CKD stages 4-5, the geographic determinants within the United States are incompletely understood. In this study, we examined interstate differences in nephrologist care among patients approaching ESRD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This national, population-based analysis included 373,986 adult patients from the US Renal Data System, who initiated maintenance dialysis between 2005 and 2009. Multilevel logistic regression was used to examine interstate variation in nephrologist care (≥12 months before ESRD) for overall and four race-age subpopulations (black or white and older or younger than 65 years).
resultsThe average state-level probability of having received nephrologist care in all states combined was 28.8% (95% confidence interval, 25.2% to 32.7%) overall and was lowest (24.3%) in the younger black subpopulation. Even at these lower levels, state-level probabilities varied considerably across states in overall and subpopulations (all P<0.001). Overall, excluding the states in the upper and lower five percentiles, the remaining states had a probability of receiving care that varied from 18.5% to 41.9%. The lower probability of receiving nephrologist care for blacks than whites among younger patients noted in most states was attenuated in older patients. Geographically, all New England states and most Midwest states had higher than average probability, whereas most Middle Atlantic and Southern states had lower than average probability. After controlling for patient factors, three state-characteristic categories, including general healthcare access measured by percentage of uninsured persons and Medicaid program performance scores, preventive care measured by percentage of receiving recommended preventive care, and socioeconomic status, contributed 55%-66% of interstate variation.
conclusionsPatients living in states with better health service and socioeconomic characteristics were more likely to receive predialysis nephrologist care. The reported national black-white difference in nephrologist care was primarily driven by younger black patients being the least likely to receive care.
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