Associations among race, residential segregation, community income, and emergency department use by adults with end-stage renal disease

Objective: The purpose of this study was to examine independent and interactive effects of race, community income, and racial residential segregation on the likelihood of ED revisits by persons with end-stage renal disease (ESRD). Design: A retrospective analysis of de-identified data abstracted from Health Care Utilization and Cost Project's (HCUP) 2014 New Jersey State Emergency Department (ED) Database and American Community Survey (ACS) was conducted. Sample: The analytic sample was comprised of 2,859 ED encounters in 2014 by non-Hispanic Black and White persons over 18 years of age with ESRD who were treated and released from the ED. Measurements: The HCUP database was the data source for ED revisit, race, median community income, and covariate (age, gender, marital status, number of chronic conditions) variables in the study. The 2014 ACS was the source for racial segregation Dissimilarity Index scores across NJ counties. Results: Living in communities with lower median income and high racial segregation was associated with a higher likelihood of ED revisits. Black race interacted with community income and racial segregation in its effect on ED revisits. Conclusion: Efforts are needed to direct geo-targeted interventions and resources to socially disadvantaged communities to lessen disparities in ED visits among dialysis patients.