SDOH and Healthcare Use in Patients with ADPKD

In a poster session at NKF SCM22, Karl Kilgore, PhD, and colleagues reported the results of a study designed to examine the relationship between social determinants of health (SDOH) and healthcare resource utilization (HRU) and costs in patients with commercial and managed Medicaid health insurance with autosomal dominant polycystic kidney disease (ADPKD). The poster was titled Impact of Social Determinants of Health (SDOH) and Specialist Care on Healthcare Resource Utilization (HRU) and Costs in Autosomal Dominant Polycystic Kidney Disease (ADPKD).

The study used data from a national claims database. The commercial insurance group included 8766 patients and the managed Medicaid group included 5416 patients. Eligible patients had two or more International Classification of Diseases, Tenth Revision, Clinical Modification codes for ADPKD between July 1, 2016, and December 31, 2018, and were continuously enrolled in a commercial or managed Medicaid insurance plan for 12 or more months.

Nine-digit ZIP codes, rather than Census data, were used to link patients to SDOH. HRU included inpatient days and visits to the emergency department (ED) per 1000 patients per month and total healthcare costs over 1-year of follow. The two cohorts (commercial and managed Medicaid) were analyzed separately.

The proportion of female patients was higher in the managed Medicaid group compared with the commercial insurance group (60% vs 54%). Patients in the managed Medicaid group were, on average, 8 years younger than those in the commercial group. Managed Medicaid patients had 1.3 times higher scores on the Charlson Comorbidity Index scale, had 40% lower income, lived alone 1.3 times more often, fell below the federal poverty level 2 times more often, completed high school 1.3 times less often, and spoke English not well/at all 2.7 times more often.

There were associations between lower education level and living alone and higher inpatient days and ED utilization for both groups, and for patients in the managed Medicaid group, higher total healthcare costs. There was also an association between lower income and increased ED visits. There were no consistent associations between other SDOH and outcomes.

Healthcare resource utilization and total healthcare costs were significantly higher among patients with ADPKD who saw certain specialists (hematologist, cardiologist, or mental health provider) compared with those who did not. The trend was opposite among patients who saw a nephrologist.

In conclusion, the authors said, “ADPKD patients with higher rates of certain social risk factors had higher inpatient days and ED utilization and higher total healthcare costs than those with lower social risk factors. Managed Medicaid patients had higher rates of social risk factors than commercial patients overall. Identifying and addressing social risk factors in these patients are recommended to reduce avoidable healthcare resource utilization and costs and the healthcare disparities which are the likely cause of these disparage outcomes. In addition, patients who were seen by nephrologists had lower healthcare resource utilization and costs than those who were not, after controlling for SDOH and other factors. This suggests that ADPKD may present unique clinical challenges which are most effectively addressed by the appropriate medical specialist.”

The study was sponsored by Otsuka Pharmaceutical Development & Commercialization, Inc.

Source: Kilgore K, Pareja K, Teigland C, et al. Impact of social determinants of health (SDOH) and specialist care in healthcare resource utilization (HRU) and costs in autosomal dominant polycystic kidney disease (ADPKD). Abstract of a poster (Poster #345) presented at the National Kidney Foundation 2022 Spring Clinical Meetings, Boston, Massachusetts, April 6-10, 2022.