OBJECTIVES:

Individuals with chronic kidney disease (CKD) are more likely to be hospitalized, yet the impact of neighborhood Socioeconomic Status (SES) on hospitalizations among those with CKD remains poorly understood. This study aims to evaluate the geographic variation of hospitalizations with a CKD diagnosis in Texas and identify the associations with county-level SES.

METHODS:

A cross-sectional analysis was conducted using 2021 Texas Inpatient Public Use Data, which includes statewide discharge information from Texas hospitals. Hospitalizations with a CKD diagnosis (CKD-Hosp) were identified. Heatmaps were created for the number of CKD-Hosp by county and for CKD-Hosp rates and normalized by the county population. Hospital discharge data were supplemented with county-level SES index constructed using data from the American Community Survey. Ordinary least square (OLS) regression models were estimated to identify the associations between county-level SES and CKD-Hosp rates.

RESULTS:

In 2021, there were 2,455,233 hospitalizations among Texas residents aged 18 years and above, of which 441,466 (18.0%) had a CKD diagnosis (CKD-Hosp). The number of CKD-Hosp is strongly correlated with county population, with high concentrations within or near metropolitan/urban areas. After adjusting for county population, the average CKD-Hosp rate in 254 Texas counties was 1,687±604 per 100,000 people. Disparities in income, property values, poverty, unemployment, and education were associated with statistically significant differences in CKD-Hosp rates. The top 25% of counties with highest SES index scores have on average 422 fewer CKD-Hosps per 100,000 people compared with the bottom 25% of counties (P<0.001).

CONCLUSIONS:

The study reveals substantial disparities in CKD-Hosp rates across Texas counties. Counties with higher SES exhibit notably fewer CKD-Hosps per 100,000 people compared to lower SES counties with the understood limitation of residual confounding. These findings underscore the critical need to address socioeconomic disparities as a potential avenue for mitigating the burden of hospitalizations among CKD patients.