Race, Income, and Medical Care Spending Patterns in High-Risk Primary Care Patients: Results From the STOP-DKD (Simultaneous Risk Factor Control Using Telehealth to Slow Progression of Diabetic Kidney Disease) Study.
Date
2022-01
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Abstract
Rationale & objective
Little is known about how socioeconomic status (SES) relates to the prioritization of medical care spending over personal expenditures in individuals with multiple comorbid conditions, and whether this relationship differs between Blacks and non-Blacks. We aimed to explore the relationship between SES, race, and medical spending among individuals with multiple comorbid conditions.Study design
Cross-sectional evaluation of baseline data from a randomized controlled trial.Setting & participants
The STOP-DKD (Simultaneous Risk Factor Control Using Telehealth to Slow Progression of Diabetic Kidney Disease) study is a completed randomized controlled trial of Duke University primary care patients with diabetes, hypertension, and chronic kidney disease. Participants underwent survey assessments inclusive of measures of socio-demographics and medication adherence.Predictors
Race (Black or non-Black) and socioeconomic status (income, education, and employment).Outcomes
The primary outcomes were based on 4 questions related to spending, asking about reduced spending on basic/leisure needs or using savings to pay for medical care. Participants were also asked if they skipped medications to make them last longer.Analytical approach
Multivariable logistic regression stratified by race and adjusted for age, sex, and household chaos was used to determine the independent effects of SES components on spending.Results
Of 263 STOP-DKD participants, 144 (55%) were Black. Compared with non-Blacks, Black participants had lower incomes with similar levels of education and employment but were more likely to reduce spending on basic needs (29.2% vs 13.5%), leisure activities (35.4% vs 20.2%), and to skip medications (31.3% vs 15.1%), all P < 0.05. After multivariable adjustment, Black race was associated with increased odds of reduced basic spending (OR, 2.29; 95% CI, 1.14-4.60), reduced leisure spending (OR, 1.94; 95% CI, 1.05-3.58), and skipping medications (OR, 2.12; 95% CI, 1.12-4.04).Limitations
This study was conducted at a single site in Durham, North Carolina, and nearly exclusively included insured patients. Further, the impact of the number of comorbid conditions, medication costs, or copayments was not assessed.Conclusions
In primary care patients with multiple chronic diseases, Black patients are more likely to reduce spending on basic needs and leisure activities to afford their medical care than non-Black patients of equivalent SES.Clinicaltrialsgov identifier
NCT01829256.Type
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Publication Info
Machen, Leah, Clemontina A Davenport, Megan Oakes, Hayden B Bosworth, Uptal D Patel and Clarissa Diamantidis (2022). Race, Income, and Medical Care Spending Patterns in High-Risk Primary Care Patients: Results From the STOP-DKD (Simultaneous Risk Factor Control Using Telehealth to Slow Progression of Diabetic Kidney Disease) Study. Kidney medicine, 4(1). p. 100382. 10.1016/j.xkme.2021.08.016 Retrieved from https://hdl.handle.net/10161/29626.
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Scholars@Duke
Hayden Barry Bosworth
Dr. Bosworth is a health services researcher and Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Medical Center. He is also Vice Chair of Education and Professor of Population Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities.
Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 30 trials resulting in over 400 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, private payers, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.
Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy
Uptal Dinesh Patel
Uptal Patel, MD is an Adjunct Professor interested in population health with a broad range of clinical and research experience. As an adult and pediatric nephrologist with training in health services and epidemiology, his work seeks to improve population health for patients with kidney diseases through improvements in prevention, diagnosis and treatment. He has led clinical and translational research programs to improve detection and management of kidney disease in a variety of populations.
His current efforts seek to advance targeted therapies for immune-mediated diseases as the Senior Vice President and Head of Development at HI-Bio, at Biogen. Prior to being CMO at HI-Bio, he led clinical strategy, translation, and development of the kidney portfolios at AstraZeneca (within the early cardiovascular, renal, and metabolism therapeutic area) and Gilead Sciences (within the inflammation therapeutic area).
He currently also serves as Chair of the Board of Directors for the Kidney Health Initiative, a public-private partnership between the American Society of Nephrology and the FDA to catalyze innovation and the development of safe and effective patient-centered therapies for people with kidney diseases. He completed training at the University of Michigan in internal medicine, pediatrics, adult nephrology, pediatric nephrology, and health services research after attending medical school at UCSF.
Clarissa Jonas Diamantidis
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