Hispanic and Asian patients with chronic kidney disease (CKD) are disproportionally affected by a lack of health care access, investigators reported at the National Kidney Foundation’s 2022 Spring Clinical Meetings in Boston, Massachusetts.
Lack of mental health care is a common problem for the vast majority of patients with CKD.
In a study of 2619 patients with CKD from the 2013-2018 National Health and Nutrition Examination Survey (NHANES) databases, 6.4% of Hispanic, 4.3% of Asian, 2.0% of Black, and 1% of White patients were missing all 4 components of health care access. They had no insurance, no routine place for health care services, no health care visit in the past year, and no access to mental health services in the past year, PhD student Sadia Anjum Ashrafi and colleagues from the University of Illinois at Urbana-Champaign reported in a poster presentation.
In adjusted analyses, Hispanic patients had 2.2-, 1.9-, and 1.8-fold increased odds of no insurance, no routine place for health care, and no health care visit in the past year, respectively, compared with White patients. Asian patients had 3.7-fold increased odds of no access to mental health services compared with White patients.
The vast majority of patients with CKD (91%) in the 2013-2018 NHANES database had no access to mental health services, Ashrafi highlighted in the poster presentation.
According to the investigators, “policy-level interventions targeting these populations are necessary to improve their access to care.”
In 2019, the World Kidney Day committee highlighted the problem of access to care. In 2020, the World Kidney Day committee focused on “Kidney Health for Everyone Everywhere.
Mental Health Care
Access to mental health care is a necessity for many patients with CKD. In a recent review published in the Clinical Journal of the American Society of Nephrology, Clodagh Cogley, a PhD candidate at the University College Dublin in Dublin, Ireland, and colleagues highlighted the burden of mental illness in the CKD population. Depression and anxiety are highly prevalent among individuals with CKD. In addition, patients with severe mental illness, such as schizophrenia and bipolar disorder, have a higher risk of developing CKD.
Patients with severe mental illness receive suboptimal kidney care, have fewer appointments with nephrologists, and are less likely to receive a kidney transplant, the reviewers reported. Hospitalization and mortality rates are also higher among this population.
“As health care disparities for individuals with CKD and co-occurring severe mental illness are multidimensional, close multidisciplinary collaboration is needed to improve health care access and health outcomes for this population,” according to Cogley’s team.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Ashrafi SA, Alam RB, Ogunjesa BA, Schwingel A. Racial disparities in health care access among chronic kidney disease patients. Presented at the National Kidney Foundation 2022 Spring Clinical Meetings, April 6-10, 2022. Poster 201.
Cogley C, Carswell C, Bramham K, Chilcot J. Chronic kidney disease and severe mental illness. Clin J Am Soc Nephrol. Published online March 31, 2022. doi:10.2215/CJN.15691221