Dialysis Patients Living in Poor Neighborhoods | Loyola Medicine

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Monday, June 15, 2015

More dialysis patients living in poor neighborhoods, study finds

Dialysis equipment

MAYWOOD, IL – Poverty is known to be a strong risk factor for end-stage kidney disease. Now, a first of-its-kind study has found that the association between poverty and kidney disease changes over time.

The percentage of adults beginning kidney dialysis who lived in zip codes with high poverty rates increased from 27.4 percent during the 1995-2004 time period to 34 percent in 2005-2010.

The study, by corresponding author Holly Kramer, MD, MPH and colleagues at Loyola University Chicago Stritch School of Medicine, is published in the journal Hemodialysis International.

Researchers examined data from the Centers for Medicare and Medicaid Services, as supplied by the US Renal Data System.

The Renal Data System does not provide data on incomes of individual dialysis patients. So researchers instead examined whether an individual patient lived in a poverty area, defined as a zip code in which at least 20 percent of the population lives below the federal poverty line.

The study demonstrated that, compared with the general population, adults beginning dialysis are more likely to be living in a poor zip code: 27.4 percent of adults beginning dialysis in 1995-2004 lived in poor zip codes, compared with 10.9 percent of the general population; the corresponding figures for 2005-2010 were 34 percent and 12.5 percent.

It remains unclear why living in a poor zip code is linked to end stage kidney disease. Some possibilities include access to health care, environmental toxin exposures that are more likely in poverty areas and individual lifestyle factors, researchers wrote.

Future studies of end stage kidney disease patients should examine tends over time in poverty at the individual level and in smaller geographic areas, such as census tracts, Dr. Kramer and colleagues wrote.

“The collection of such data may help track national and local trends in poverty status and be used to develop policies for improving health outcomes and disease prevention,” they wrote.

Dr. Kramer, a kidney specialist, is an associate professor in the departments of Medicine and Public Health Sciences of Loyola University Chicago Stritch School of Medicine. Co-authors are Bridget H. Garrity, MPH (first author), Kavitha Vellanki, MD, David Leehey, MD, Julia Brown, MD and David A. Shoham, PhD.

The study is titled, “Time trends in the association of ESRD incidence with the areal-level poverty in the US population.”

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 92 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 129,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.