title: Access to care and the incidence of endstage renal disease due to systemic lupus erythematosus.
abstract: OBJECTIVE
  Persons with low socioeconomic status have an increased risk of endstage renal disease (ESRD) due to systemic lupus erythematosus (SLE), possibly because of limited access to care. We examined if the incidence of ESRD due to SLE was higher in geographic areas with poorer access to care.
  
  
  METHODS
  In this population-based ecological study, we tested associations between the incidence of ESRD due to SLE and the proportion of hospitalizations with no insurance, Medicaid or managed care insurance, residence in a primary care-provider shortage area or rural area, and rate of hospitalizations for ambulatory care-sensitive conditions, by ZIP code in California in 1999-2004.
  
  
  RESULTS
  The incidence of ESRD due to SLE was higher in ZIP codes with higher proportions of hospitalizations with no insurance (r = 0.22, p < 0.0001) or Medicaid (r = 0.21, p < 0.0001), and in ZIP codes with higher rates of hospitalizations for ambulatory care-sensitive conditions (r = 0.23, p < 0.0001). In multivariate analyses, incidences were higher in ZIP codes with higher proportions of hospitalizations with Medicaid (p < 0.0001) and higher rates of hospitalizations for ambulatory care-sensitive conditions (p = 0.06), independent of the socioeconomic status of the ZIP code residents.
  
  
  CONCLUSIONS
  The incidence of ESRD due to SLE is higher in areas with higher proportions of residents who have public insurance and higher rates of avoidable hospitalizations, suggesting that limited access to care may contribute to this complication of SLE.
authors.affiliation: Intramural Research Program, NIAMS/NIH, Building 10 CRC, Room 4-1339, 10 Center Drive, MSC 1468, Bethesda, MD 20892, USA. wardm1@mail.nih.gov
authors.forename: Michael M
authors.initials: MM
authors.lastname: Ward
mesh_terms: D000328:Adult; D002140:California / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D015276:Health Care Rationing / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D008180:Lupus Erythematosus, Systemic / Q000191:economics / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data; D018579:Patient Selection; D012923:Social Class; D014481:United States; D055815:Young Adult
references.citation: Arthritis Rheum. 2007 May 15;57(4):593-600
references.pmid: 17471526
references.citation: J Rheumatol. 1998 Sep;25(9):1720-9
references.pmid: 9733452
references.citation: Arch Intern Med. 2007 May 28;167(10):1083-91
references.pmid: 17533212
references.citation: J Health Soc Behav. 1995 Mar;36(1):1-10
references.pmid: 7738325
references.citation: Am J Med. 2006 Apr;119(4):355.e25-33
references.pmid: 16564783
references.citation: Arthritis Rheum. 1997 Jan;40(1):47-56
references.pmid: 9008599
references.citation: Arthritis Care Res. 2000 Dec;13(6):406-8
references.pmid: 14635317
references.citation: Arthritis Rheum. 2006 Jul;54(7):2211-9
references.pmid: 16802357
references.citation: Health Place. 2007 Mar;13(1):179-87
references.pmid: 16443385
references.citation: Arthritis Rheum. 2007 May 15;57(4):601-7
references.pmid: 17471527
references.citation: J Rheumatol. 2009 Jan;36(1):63-7
references.pmid: 19004042
references.citation: Am J Med. 1991 Oct;91(4):345-53
references.pmid: 1951378
references.citation: Ann Rheum Dis. 2003 May;62(5):435-9
references.pmid: 12695156
references.citation: Arch Intern Med. 2000 Nov 13;160(20):3136-40
references.pmid: 11074743
references.citation: J Rheumatol. 2006 Aug;33(8):1563-9
references.pmid: 16881113
references.citation: Medicine (Baltimore). 2003 Sep;82(5):299-308
references.pmid: 14530779
references.citation: Am J Kidney Dis. 2008 Apr;51(4):563-72
references.pmid: 18371532
references.citation: Rheumatology (Oxford). 2006 Sep;45(9):1144-7
references.pmid: 16527882
references.citation: J Ambul Care Manage. 2003 Oct-Dec;26(4):334-43
references.pmid: 14567277
references.citation: Rheumatology (Oxford). 1999 Nov;38(11):1130-7
references.pmid: 10556268
references.citation: Nephrol Dial Transplant. 2007 Sep;22(9):2531-9
references.pmid: 17510096
references.citation: JAMA. 1995 Jul 26;274(4):305-11
references.pmid: 7609259
references.citation: J Rheumatol. 2007 Oct;34(10):2024-7
references.pmid: 17696272
references.citation: JAMA. 1992 Nov 4;268(17):2388-94
references.pmid: 1404795
references.citation: Med Care. 1994 Jan;32(1):81-90
references.pmid: 8277803
references.citation: J Rheumatol. 2005 May;32(5):913-9
references.pmid: 15868630
references.citation: PLoS Med. 2006 Oct;3(10):e396
references.pmid: 17076550