Associations among race, residential segregation, community income, and emergency department use by adults with end‐stage renal disease

Abstract

Objective The purpose of this study was to examine independent and interactive effects of race, community income, and racial residential segregation on the likelihood of ED revisits by persons with end‐stage renal disease (ESRD). Design A retrospective analysis of de‐identified data abstracted from Health Care Utilization and Cost Project's (HCUP) 2014 New Jersey State Emergency Department (ED) Database and American Community Survey (ACS) was conducted. Sample The analytic sample was comprised of 2,859 ED encounters in 2014 by non‐Hispanic Black and White persons over 18 years of age with ESRD who were treated and released from the ED. Measurements The HCUP database was the data source for ED revisit, race, median community income, and covariate (age, gender, marital status, number of chronic conditions) variables in the study. The 2014 ACS was the source for racial segregation Dissimilarity Index scores across NJ counties. Results Living in communities with lower median income and high racial segregation was associated with a higher likelihood of ED revisits. Black race interacted with community income and racial segregation in its effect on ED revisits. Conclusion Efforts are needed to direct geo‐targeted interventions and resources to socially disadvantaged communities to lessen disparities in ED visits among dialysis patients.

Racial/ethnic segregation and health disparities: Future directions and opportunities

“…Bellatorre et al () are among the first to empirically link segregation to allostatic load and Hao et al () extended segregation to cancer survivors' health‐related quality of life, though Massey () already proposed a theoretical connection between segregation and allostatic load. It should be noted that since 2017, several scholars have reported that segregation is related to the availability of health care resources (Caldwell et al, ), health behaviors (Tempalski et al, ; Thomas‐Hawkins et al, ), and neurological disorder (Pennap et al, ).…”

Emergency Department Utilization Among Maintenance Hemodialysis Patients: A Systematic Review

“…2 Access to care is also modulated by other social determinants of health, such as race and residential segregation. 30,60 HD patients require regularly scheduled dialysis, which is among the greatest burdens of their disease experience. 1,61 Missed dialysis is associated with ED visits, hospitalizations, and mortality.…”

“…3,7,[18][19][20][21][22][23][24][25] Higher ED utilization was also predicted by the following social determinants of health: racial segregation, lower community income, female sex, Black race, reliance on public transport, and lower health literacy. [26][27][28][29][30] The undocumented and social determinants of health concept subgroups were treated separately to reflect the unique barriers to care that undocumented persons face in the United States, such as their ineligibility for Medicare. 54 Several studies demonstrated an association between undocumented status and higher rates of ED visits.…”

Role of HEART score in evaluating clinical outcomes among emergency department patients with different ethnicities

“…22 Similarly, the HEART score may have less power to predict 30-day ED returns among our study cohort because many risks could affect patient short-term ED returns such as no insurance coverage, poor education, less income, and homelessness. [23][24][25][26] The present study cohort might have high psychosocial risk, which could potentially prevent accurate prediction of ED returns. Our findings emphasize that the HEART score may be suitable for only certain clinical outcomes.…”