Income-based disparities in outcomes for patients with chronic kidney disease.
Semin Nephrol
; 21(4): 377-85, 2001 Jul.
Article
en En
| MEDLINE
| ID: mdl-11455526
ABSTRACT
The impact of income on outcomes for patients with end-stage renal disease (ESRD), who are largely relieved of structural and financial barriers to care, is poorly understood. We conducted a prospective cohort study of 3,165 patients who developed ESRD in the early 1990s to examine whether low-income patients with ESRD have poorer health outcomes than their socioeconomically advantaged counterparts, and, if so, to determine whether greater health insurance can reduce this disparity. We found that increasing neighborhood income was associated with decreased mortality and an increased likelihood of placement on the renal transplant waiting list. The presence of private insurance coverage in addition to Medicare improved rates of listing for transplantation in a graded manner, with the greatest effect among those living in neighborhoods below the 10th percentile of income, but had no effect on socioeconomic disparities in mortality. Our results suggest that low-income patients with ESRD experience persistent financial barriers to transplantation that can be addressed with greater health benefits. However, they also experience higher mortality that is caused by personal and/or environmental factors that differ by social class. Clinicians, researchers, and policymakers must address these social, cultural, psychologic, and environmental determinants of health to improve the survival of patients with ESRD.
Buscar en Google
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Diálisis Renal
/
Evaluación de Resultado en la Atención de Salud
/
Renta
/
Seguro de Salud
/
Fallo Renal Crónico
Tipo de estudio:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prevalence_studies
/
Prognostic_studies
/
Risk_factors_studies
Aspecto:
Determinantes_sociais_saude
Límite:
Adult
/
Aged
/
Humans
/
Middle aged
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Semin Nephrol
Año:
2001
Tipo del documento:
Article
País de afiliación:
Estados Unidos