High Prevalence Of Social Determinants Of Health Insecurities In Hemodialysis Access Patients In A Safety-net Setting
Max Zhu, BS1, Nkiruka Arinze, MD2, Andrea Alonso, MD2, Scott Levin, MD2, Jeffrey J. Siracuse, MD, MBA1.
1Boston University, Boston, MA, USA, 2Boston Medical Center, Boston, MA, USA.
OBJECTIVES: Patients receiving hemodialysis access surgery often have challenges related to social determinants of health (SDH). Our goal was to characterize the SDH issues experienced by our arteriovenous (AV) access patients and identify differences in health outcomes.
METHODS: We performed a retrospective chart review of all patients who underwent AV access creation (2017-2021) who responded to a SDH survey (titled THRIVE) implemented at our institution. Demographics, procedural details, perioperative outcomes, THRIVE responses, and referral to our hospital's preventative food pantry were recorded. Univariable analysis and multivariable analyses were performed to assess for associations with perioperative outcomes.
RESULTS: There were 190 patients that responded to THRIVE survey within one year of their surgery date, of which 42 (22%) patients identified at least one SDH challenge on the THRIVE survey. Average age was 60, 61% identified as male gender, and 64% identified as Black race. Common comorbidities include hypertension (93%), diabetes (68%), hyperlipidemia (60%), heart failure (32%), and coronary artery disease (31%). 37% of patients received food pantry referrals. AV accesses created were 39% brachiocephalic, 25% brachiobasilic, 16% radiocephalic fistulas, and 14% AV grafts. More than half (56%) had a tunneled dialysis catheter (TDC) at time of access creation. On THRIVE survey, excluding missing responses, 7% of respondents indicated unstable housing, 16% food insecurity, 12% trouble paying for medication, 18% trouble getting transportation to medical appointments, 13% trouble paying for utilities, 6% trouble caring for family or friends, 9% unemployed and seeking employment, and 5% wanted more education. Perioperative outcomes included 23% with 30-day emergency department visit, 21% with 30-day readmission, and 2% with 90-day mortality. On multivariable analysis, any SDH determined on THRIVE survey and food pantry referral were not associated with examined outcomes.
CONCLUSIONS: Nearly a quarter of hemodialysis access surgery patients at our safety-net hospital experience social disparities as identified on THRIVE survey. Most common disparities experienced include food insecurity, trouble getting transportation for medical appointments, and difficulty paying for utilities and medication. Further prospective analysis is needed to better understand how these SDH challenges can affect outcomes and overall health.
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