1493-P: The Impact of Adverse Social Determinants on Health Care Utilization and Expenditures among U.S. Adults with DKD

Abstract

Introduction: This study examined whether adverse social determinants of health (SDOH) are associated with higher health care utilization and out of pocket (OOP) expenditures in U.S. adults with diabetic kidney disease (DKD). Methods: Data from 458 adults with self-reported DKD age ≥50 from the Health and Retirement Study 2008-2012 was analyzed. Primary outcomes were number of hospital overnight stays (HOS), number of physician visits (PV) and OOP expenditures. Primary independent variables were nine adverse SDOH factors clustered around three SDOH domains: psychosocial (depression, perceived social support and discrimination); financial hardship (difficulty paying bills, food insecurity, medication cost non-adherence); neighborhood (neighborhood social cohesion, social participation and physical disorder). Two variables were created, a continuous 0-9 and a categorical variable of 0, 1-2, 3+. We used negative binomial regression and marginalized two-part models to determine the impact of adverse SDOH on outcomes. Results: In the unadjusted model, compared to adults with no adverse SDOH, adults with 3+ adverse SDOH had 3% lower likelihood of PV (95%CI 0.72-1.29), 75% (95%CI 1.10-2.79) and 87% (95%CI 1.31-2.65) higher likelihood of HOS and OOP expenditures respectively. In the adjusted model, having 3+ adverse SDOH was not significantly associated with PV (Ratio 0.94 95%CI 0.69-1.29) or HOS (Ratio 1.53 95%CI 0.93-2.49) but was associated with a 2-fold higher likelihood of OOP expenditures (95% CI 1.60-3.31). Adverse neighborhood factors were associated with 63% higher likelihood of HOS (adjusted 95% CI 1.19-2.24) and financial hardship factors were associated with 85% higher likelihood of OOP expenditures (adjusted 95% CI 1.42-2.41). Conclusions: Our findings suggest having 3+ adverse SDOH especially financial hardship impacts OOP expenditures in adults with DKD. Interventions targeting adults with 3+ adverse SDOH may significantly decrease OOP expenditures in DKD. Disclosure M.N. Ozieh: None. E. Garacci: None. R.J. Walker: None. L.E. Egede: None. Funding American Diabetes Association (1-19-JDF-075 to R.J.W.); Advancing Healthier Wisconsin/Clinical and Translational Science (UL1TR001436, KL2TR001438); National Institutes of Health (K24DK093699, R01DK118038, R01DK120861, R01MD013826)