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Racial/Ethnic Inequities in Access to High-Quality Dialysis Treatment in Chicago: Does Neighborhood Racial/Ethnic Composition Matter?

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Abstract

Objectives

Blacks and Hispanics face a higher incidence rate of end-stage renal disease (ESRD) and tend to experience poorer access to quality health care compared with Whites. Income, education, and insurance coverage differentials are typically identified as risk factors, but neighborhood-level analyses may provide additional insights. We examine whether neighborhood racial composition contributes to racial/ethnic inequities in access to high-quality dialysis care in Chicago.

Methods

Data are drawn from the United States Renal Data System merged to the ESRD Quality Incentive Program file and the American Community Survey (2005–2009) for facility and neighborhood characteristics (N = 2797). Outcomes included (1) spatial access (travel time to dialysis facilities) and (2) realized access (actual use of quality care). Neighborhood racial/ethnic composition was categorized into four types: predominantly White, Black, and Hispanic neighborhoods, and racially integrated neighborhoods.

Results

Blacks lived closer to a dialysis facility but traveled the same distance to their own dialysis compared with Whites. Hispanics had longer travel time to any dialysis than Whites, and the difference between Hispanics and Whites became no longer significant after adjusting for neighborhood racial/ethnic composition. Blacks and Hispanics had better access to a high-quality facility if they lived in integrated neighborhoods (OR = 1.85 and 3.77, respectively, p < 0.01) or in neighborhoods with higher concentrations of their own race/ethnicity (OR = 1.68 for Blacks in Black neighborhoods and 1.92 for Hispanics in Hispanic neighborhoods, p < 0.05) compared with Whites in predominantly White neighborhoods.

Conclusion

Expanding opportunities for Blacks and Hispanics to gain access to racially integrated and minority neighborhoods may help alleviate racial/ethnic inequities in access to quality care among kidney disease patients.

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Funding

This work was supported by pilot awards from the University of Chicago’s Center for Health Administration Studies (CHAS) and the Population Research Center. H. Lee is supported by an NIH/NIA training grant at the University of Southern California (T32AG000037). J. T. Caldwell was supported by the Agency for Healthcare Research and Quality at the time of this project (4T32-HS78-18). M. R. Saunders is supported by a career development award from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK K23 DK103111).

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Authors and Affiliations

  1. Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Avenue Room 221, Los Angeles, CA, 90089-0191, USA

    Haena Lee

  2. General Internal Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA

    Julia T. Caldwell & Milda R. Saunders

  3. Center for Asian Health Equity, University of Chicago, Chicago, IL, USA

    Chieko Maene

  4. Department of Sociology, University of Chicago, Chicago, IL, USA

    Kathleen A. Cagney

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  1. Haena Lee
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Correspondence to Haena Lee.

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Institutional review board (IRB) approval was received from the University of Chicago. For this type of study, formal consent is not required.

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The views expressed in this manuscript are those of the authors and do not necessarily represent the views of the National Institutes of Health and the National Institutes of Diabetes and Digestive and Kidney Diseases. The funders had no role in the study design, collection, analysis, interpretation of data, writing the report, or the decision to submit the report for publication.

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Lee, H., Caldwell, J.T., Maene, C. et al. Racial/Ethnic Inequities in Access to High-Quality Dialysis Treatment in Chicago: Does Neighborhood Racial/Ethnic Composition Matter?. J. Racial and Ethnic Health Disparities 7, 854–864 (2020). https://doi.org/10.1007/s40615-020-00708-8

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