731 - Impact of Social Determinants of Health on the Health Outcomes of Children with Chronic Kidney Disease (CKD)

Publication Number: 731.5225

Christel Wekon-Kemeni, Emory University School of Medicine, Atlanta, GA, United States; Katie Liu, Emory University School of Medicine, Atlanta, GA, United States; Adrianna Westbrook, Emory University School of Medicine, Atlanta, GA, United States; jonathan M. Beus, Emory University School of Medicine, Atlanta, GA, United States; Jessica Harding, Emory University School of Medicine, Atlanta, GA, United States; Hyunjung Stella. Shin, Children's Healthcare of Atlanta, Atlanta, GA, United States; Larry A. Greenbaum, Emory University School of Medicine, Decatur, GA, United States; Chia-shi Wang, Emory University School of Medicine, Atlanta, GA, United States

Background: Children with CKD have high morbidity and hospitalization rate. The impact of demographic, socioeconomic, and environmental factors on outcomes in children with CKD have not been well-described.

Objective: To assess the relationship between demographic, socioeconomic, and environmental factors on eGFR at diagnosis, hospitalization/ED visit rate, and eGFR decline in children with CKD.

Design/Methods: This retrospective cohort study included children with CKD diagnosed < 18y between 2014-2023 at a single institution located in Atlanta, GA. Primary exposure was the Environmental Justice Index Social-Environmental Ranking (EJI-SER), a score measuring environmental burden and social vulnerability based on census tract. We described the distribution of demographic and clinical characteristics by EJI-SER. We examined the association between EJI-SER and eGFR at diagnosis (linear regression), rate of hospitalization/ED visits (negative binomial regression) and eGFR decline ≥ 40% or drop to < 15 mL/min/1.73m2 (Cox regression analysis). Models were stratified by congenital and non-congenital causes of CKD, and adjusted for race, ethnicity, sex, and insurance type/status.

Results: Black patients had higher EJI-SER scores (42% within the top quintile), indicating higher environmental burden and social vulnerability. Higher EJI-SER was significantly associated with higher rates of hospitalizations/ED visits among children with congenital/genetic causes of CKD (IRR 1.09, 95% CI 1.05, 1.14) but were not associated with eGFR at diagnosis or eGFR decline in either group. Factors significantly associated with lower eGFR at diagnosis among children with congenital/genetic causes of CKD were Black vs White race (β -12, 95% CI -16, -7.6) and having no insurance vs public insurance (β -22, 95% CI -35, -8.3). Black vs White race was also independently associated with higher rates of hospitalizations/ED visits: IRR 1.57 (95% CI 1.38, 1.78) among children with congenital/genetic causes of CKD and IRR 1.89 (95% CI 1.25, 2.84) among those with non-congenital causes. There were no significant associations between the exposure variables and eGFR decline.

Conclusion(s): Social determinants were significant factors in eGFR at diagnosis and frequency of hospitalizations/ED visits in children with CKD. Importantly, Black children have increased risk for worse kidney function at diagnosis and higher rates of hospitalizations/ED visits, even when accounting for other measured socioeconomic factors. The results highlight the need for more in-depth investigation into causative factors and targeted supportive interventions for Black patients.

Table 1.
Characteristics of Children with CKD by Underlying Disease Condition


Figure 1.
EJI-SER Score Quintiles by Race Among Children with CKD