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...

中文翻译：

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低收入、非老年人肾衰竭患者的社区卫生中心渗透率和肾脏护理结果


健康中心 （CHC） 提供负担得起的门诊护理。方法： 我们对 139,275 名年龄在 18-64 岁之间的成年人进行了一项回顾性队列研究，这些成年人在 2016-2020 年终末期肾病 （ESKD） 发作时参加了医疗补助或没有保险。我们检查了州级低收入人群的 CHC 渗透率是否与 ESKD 发病率相关，反映了 ESKD 前护理质量的过程指标，以及 ESKD 发病一年后的生存率和肾移植等待名单。我们获得了同期 1,370 个卫生资源和服务管理局 CHC 和 50 个州（和哥伦比亚特区）的人口特征。结果：低收入居民的平均 CHC 渗透率（每个州的低收入居民是 CHC 患者的百分比）为 36%（标准差，19%）。东北部（人口普查区）CHC 渗透率高的州比例最高，南部 CHC 渗透率低的州比例最高。糖尿病、高血压和肥胖症的患病率在 CHC 渗透率高的州低于低 CHC 渗透率的州。根据 CHC 渗透率，年龄和性别标准化 ESKD 发生率无显著差异。在个体水平分析中，较高的 CHC 渗透率与长期肾病治疗的可能性显著相关 （校正比值比 [OR]： 1.04 [95% 置信区间 [CI]： 1.03， 1.05]）、血液透析开始时动静脉瘘或移植物的使用（OR： 1.11 [95% CI： 1.09， 1.12]）、家庭透析使用的可能性较高 （OR： 1.04 [95% CI： 1.02， 1.05]） 和一年肾移植等待名单 （OR： 1.19 [95% CI： 1.18， 1.21]）和 ESKD 生存率 （OR： 1.06 [95% CI： 1.04， 1.07]）。 结论：在 Medicaid 参保者和未投保的肾功能衰竭成人中，较高的 CHC 渗透率与较低的肾脏疾病风险因素患病率相关，并且对 ESKD 发作的准备程度更高，生存率更高。这些发现值得对社区卫生中心在解决肾脏健康长期差异方面的作用和影响进行进一步研究。美国肾脏病学会版权所有 © 2024...