Racial and Socioeconomic Differences in Infection Control Quality at Dialysis Centers Público
Thomas, Jacob (Spring 2022)
Abstract
Racial minorities and individuals of lower socioeconomic status with end stage renal disease experience disparities across many dimensions in the quality of dialysis care they receive. Differences in one measure of quality, infection control at dialysis facilities, have received little attention in the literature. This study uses data from the End Stage Renal Disease Quality Incentive Program (ESRD-QIP) from 2014 to 2019 to assess racial and socioeconomic differences in infection control quality at dialysis centers. It also examines trends in these differences over time, and facility, patient, and community characteristics that contribute to the observed inequalities. I find that facilities that treat a disproportionately high proportion of Black patients and those located in low-income areas are associated with lower infection control quality than facilities that treat low proportions of Black patients and those in high-income areas, respectively. In models adjusting for facility, patient, and community characteristics, dialysis centers in low-income areas continued to be associated with higher infections than facilities in high-income areas, but there was no significant association between the proportion of Black patients treated at a facility and dialysis infection control quality. Although dialysis centers overall experienced annual decreases in infections over time, the socioeconomic and racial differences in infection control quality did not change over the study period. Finally, two-stage Oaxaca-Blinder decomposition identified facility patient volume, patient age, area income, and facility profit status as the primary factors contributing to high infections at dialysis centers serving disproportionately high proportions of Black patients. These findings suggest that reducing patient volume at dialysis centers can mitigate the racial disparity in hemodialysis infections. Further improvements in health equity in dialysis care may require broader interventions that address social determinants of health in underserved patient groups.
Table of Contents
Chapter 1: Introduction 1
Chapter 2: Background and Literature Review 3
End Stage Renal Disease and dialysis 3
History of access to dialysis 4
Racial and socioeconomic disparities in dialysis quality 5
Dialysis Infections 5
Incentives in dialysis quality 7
Racial and Socioeconomic differences in dialysis infections 8
Chapter 3: Methodology 9
3A: Conceptual framework 9
Focal relationship 9
Mediator: Infection control practices 11
Mediator: Patient-to-staff ratio. 11
Confounders to the focal relationship 12
3B: Hypotheses 15
3C: Data sources 16
3D: Analytic sample. 18
3E: Constructs and Measures 19
3F: Analytic strategy 21
Regression models 21
Chapter 4: Results 26
4A: Sample Characteristics. 26
4B: Results from Bivariate Analyses. 27
4C: Main Analysis. 29
Results of Model 1 Log-Linear Regression Analysis 29
Results of Model 2 Log-Linear Regression Analysis 32
Results of Model 3 Oaxaca-Blinder Decomposition Analysis 35
Chapter 5: Discussion 39
5A: Key Findings 39
5B: Strengths and limitations 42
5C: Policy Implications 43
5D: Directions for future research 44
References 45
Appendix 53
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