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Samalik JM, Goldberg CS, Modi ZJ, Fredericks EM, Gadepalli SK, Eder SJ, Adler J. Discrepancies in Race and Ethnicity in the Electronic Health Record Compared to Self-report. J Racial Ethn Health Disparities 2023; 10:2670-2675. [PMID: 36418736 DOI: 10.1007/s40615-022-01445-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/19/2022] [Accepted: 11/01/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Racial and ethnic disparities are commonplace in health care. Research often relies on sociodemographic information recorded in the electronic health record (EHR). Little evidence is available about the accuracy of EHR-recorded sociodemographic information, and none in pediatrics. Our objective was to determine the accuracy of EHR-recorded race and ethnicity compared to self-report. METHODS Patients/guardians enrolled in two prospective observational studies (10/2014-1/2019) provided self-reported sociodemographic information. Corresponding EHR information was abstracted. EHR information was compared to self-report, considered "gold standard." Agreement was evaluated with Cohen's kappa. RESULTS A total of 503 patients (42% female, median age 12.8 years) were identified. Self-reported race (N = 484) was 73% White, 16% Black or African American (AA), 4% Asian, 5% multiracial, and 2% other. Self-reported ethnicity (N = 410) was 9% Hispanic/Latino, and 88% non-Hispanic/Latino. Agreement between self-reported and EHR-recorded race was substantial (kappa = 0.77, 95% CI 0.72-0.83). Race was discordant among 10% (47/476). Hispanic/Latino ethnicity also had strong agreement (kappa = 0.77, 95% CI 0.65-0.89). Among those who self-reported Hispanic/Latino and reported race (N = 21), race was less accurately recorded in the EHR (kappa = 0.26, 95% CI 0-0.54). Race did not match among 43% with recorded race (9/21). Among self-reported racial and/or ethnic minorities, 13% (12/164) were misclassified in the EHR as non-Hispanic White. CONCLUSIONS We found race and ethnicity are often inaccurately recorded in the EHR for patients who self-identify as minorities, leading to under-representation of minorities in the EHR. Inaccurately recorded race and ethnicity has important implications for disparity research, and for informing health policy. Reliable processes are needed to incorporate self-reported race and ethnicity in the EHR at institutional and national levels.
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Affiliation(s)
- Joann M Samalik
- Division of Pediatric Gastroenterology, 1500 E. Medical Center Dr. C.S. Mott Children's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Caren S Goldberg
- Division of Pediatric Cardiology, 1500 E. Medical Center Dr. C.S. Mott Children's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Zubin J Modi
- Susan B. Meister Child Health Evaluation and Research Center, 2900 Plymouth Rd, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
- Division of Pediatric Nephrology, 1500 E. Medical Center Dr. C.S. Mott Children's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Emily M Fredericks
- Susan B. Meister Child Health Evaluation and Research Center, 2900 Plymouth Rd, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
- Division of Pediatric Psychology, 1500 E. Medical Center Dr. C.S. Mott Children's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Samir K Gadepalli
- Susan B. Meister Child Health Evaluation and Research Center, 2900 Plymouth Rd, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
- Division of Pediatric Surgery, 1500 E. Medical Center Dr. C.S. Mott Children's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sally J Eder
- Susan B. Meister Child Health Evaluation and Research Center, 2900 Plymouth Rd, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jeremy Adler
- Division of Pediatric Gastroenterology, 1500 E. Medical Center Dr. C.S. Mott Children's Hospital, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
- Susan B. Meister Child Health Evaluation and Research Center, 2900 Plymouth Rd, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
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Chua AN, Kumar R, Warady BA. Care of the pediatric patient on chronic peritoneal dialysis. Pediatr Nephrol 2022; 37:3043-3055. [PMID: 35589990 DOI: 10.1007/s00467-022-05605-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/29/2022] [Accepted: 04/30/2022] [Indexed: 01/10/2023]
Abstract
Peritoneal dialysis is the most commonly prescribed dialysis modality for infants and young children with kidney failure worldwide. Provision of high-quality care for the pediatric patient on chronic peritoneal dialysis requires a multidisciplinary approach and a strong collaboration with the patient and their caregiver. This article not only reviews current recommendations and advances in the care of pediatric patients on peritoneal dialysis with a focus on the provision of high-quality care and improvement in outcomes, but it also draws attention to health care disparities that exist locally and globally.
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Affiliation(s)
- Annabelle N Chua
- Division of Pediatric Nephrology, Department of Pediatrics, Duke Children's Hospital, Duke University School of Medicine, Box 3959, Durham, NC, 27710, USA.
| | - Reeti Kumar
- Division of Pediatric Nephrology, Department of Pediatrics, Duke Children's Hospital, Duke University School of Medicine, Box 3959, Durham, NC, 27710, USA
| | - Bradley A Warady
- Division of Nephrology, University of Missouri-Kansas City School of Medicine, Children's Mercy Kansas City, Kansas City, MO, USA
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Policy in pediatric nephrology: successes, failures, and the impact on disparities. Pediatr Nephrol 2021; 36:2177-2188. [PMID: 32968856 DOI: 10.1007/s00467-020-04755-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/10/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
Pediatric nephrology has a history rooted in pediatric advocacy and has made numerous contributions to child health policy affecting pediatric kidney diseases. Despite this progress, profound social disparities remain for marginalized and socially vulnerable children with kidney disease. Different risk factors, such as genetic predisposition, environmental factors, social risk factors, or health care access influence the emergence and progression of pediatric kidney disease, as well as access to life-saving interventions, leading to disparate outcomes. This review will summarize the breadth of literature on social determinants of health in children with kidney disease worldwide and highlight policy-based initiatives that mitigate the adverse social factors to generate greater equity in pediatric kidney disease.
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Weaver DJ, Somers MJG, Martz K, Mitsnefes MM. Clinical outcomes and survival in pediatric patients initiating chronic dialysis: a report of the NAPRTCS registry. Pediatr Nephrol 2017; 32:2319-2330. [PMID: 28762101 DOI: 10.1007/s00467-017-3759-4] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 07/03/2017] [Accepted: 07/03/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND The 2011 annual report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) registry comprises data on 6482 dialysis patients over the past 20 years of the registry. METHODS The study compared clinical parameters and patient survival in the first 10 years of the registry (1992-2001) with the last decade of the registry (2002-2011). RESULTS There was a significant increase in hemodialysis as the initiating dialysis modality in the most recent cohort (42% vs. 36%, p < 0.001). Patients in the later cohort were less likely to have a hemoglobin <10 g/dl [odds ratio (OR) 0.68; confidence interval (CI) 0.58-0.81; p < 0.001] and height z-score <2 standard deviations (SD) below average (OR 0.68, CI 0.59-0.78, p < 0.0001). They were also more likely to have a parathyroid hormone (PTH) level two times above the upper limits of normal (OR 1.39, CI 1.21-1.60, p < 0.0001). Although hypertension was common regardless of era, patients in the 2002-2011 group were less likely to have blood pressure >90th percentile (OR 1.39, CI 1.21-1.60, p < 0.0001), and a significant improvement in survival at 36 months after dialysis initiation was observed in the 2002-2011 cohort compared with the 1992-2001 cohort (95% vs. 90%, respectively). Cardiopulmonary causes were the most common cause of death in both cohorts. Young age, growth deficit, and black race were poor predictors of survival. CONCLUSIONS The survival of pediatric patients on chronic dialysis has improved over two decades of dialysis registry data, specifically for children <1year.
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Affiliation(s)
- Donald J Weaver
- Division of Nephrology and Hypertension, Levine Children's Hospital, 1001 Blythe Boulevard, Ste 200, Charlotte, NC, 28203, USA.
| | - Michael J G Somers
- Division of Nephrology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | | | - Mark M Mitsnefes
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Chernin G, Heeringa SF, Vega-Warner V, Schoeb DS, Nürnberg P, Hildebrandt F. Adequate use of allele frequencies in Hispanics--a problem elucidated in nephrotic syndrome. Pediatr Nephrol 2010; 25:261-6. [PMID: 19876656 PMCID: PMC2899680 DOI: 10.1007/s00467-009-1315-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Revised: 08/13/2009] [Accepted: 08/13/2009] [Indexed: 01/19/2023]
Abstract
Previous studies in children with focal segmental glomerulosclerosis (FSGS) and nephrotic syndrome (NS) in the USA have revealed inter-ethnic differences in their clinical presentation and outcome. However, ethnicity was based on self-identification rather than on molecular genetic data. Here, we show that genetic heterogeneity exists in self-identified Hispanic (Spanish-American) patients with steroid-resistant nephrotic syndrome (SRNS), as patients may be either of Caucasian or Mesoamerican (Native-American) genetic background. Twenty-one self-identified Hispanic patients with SRNS from 18 families were initially evaluated for mutations in the NPHS2 and WT1 genes. All patients resided and were cared for in the USA. We performed a total genome search for linkage in all Hispanic patients using 250K single nucleotide polymorphism microarrays, comparing Caucasian with Mesoamerican allele frequencies to determine regions of homozygosity by descent and to establish the correct allele frequency for each family. We found that only ten families (56%) of the 18 self-identified Hispanic families are genetically of Mesoamerican descent, whereas the other eight families (44%) are of Caucasian descent. Due to the small number of families examined, we were unable to draw any conclusion on the prevalence of NPHS2 and WT1 in this ethnic group, but the data do suggest that self-identification of ethnicity in Hispanic-American patients is not an adequate basis for genetic studies, as this cohort may represent not only patients of Mesoamerican origin but also patients of Caucasian origin. Thus, one needs to critically review previous studies of FSGS/SRNS patients that involved Hispanic patients as a group. Future larger studies may employ a total genome search for linkage to test self-identified Hispanic ethnicity for true Mesoamerican versus Caucasian ethnicity in order to generate valid genetic data.
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Affiliation(s)
- Gil Chernin
- Departments of Pediatrics and of Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Saskia F. Heeringa
- Departments of Pediatrics and of Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Virginia Vega-Warner
- Departments of Pediatrics and of Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Dominik S. Schoeb
- Departments of Pediatrics and of Human Genetics, University of Michigan, Ann Arbor, MI, USA
| | - Peter Nürnberg
- Center for Genomics (CCG) and Institute for Genetics, Universität zu Köln, Cologne, Germany
| | - Friedhelm Hildebrandt
- Departments of Pediatrics and of Human Genetics, University of Michigan, Ann Arbor, MI, USA. Howard Hughes Medical Institute, University of Michigan, Ann Arbor, MI, USA. University of Michigan Health System, 8220C MSRB III, 1150 West Medical Center Drive, Ann Arbor, MI 48109-5646, USA
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Amaral S, Hwang W, Fivush B, Neu A, Frankenfield D, Furth S. Serum albumin level and risk for mortality and hospitalization in adolescents on hemodialysis. Clin J Am Soc Nephrol 2008; 3:759-67. [PMID: 18287254 PMCID: PMC2386701 DOI: 10.2215/cjn.02720707] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Accepted: 01/19/2008] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES National Kidney Foundation Dialysis Outcomes Quality Initiative practice guidelines recommend serum albumin > or = 4.0 g/dl for adults who are on hemodialysis. There is no established pediatric target for albumin and little evidence to support use of adult guidelines. This study examined the association between albumin and risk for death and hospitalization in adolescents who are on hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This retrospective cohort study linked data on patients aged 12 to 18 yr in 1999 and 2000 from the Centers for Medicare and Medicaid Services' End Stage Renal Disease Clinical Performance Measures Project with 4-yr hospitalization and mortality records in the United States Renal Data System. Albumin was categorized as < 3.5/3.2, > or = 3.5/3.2 and < 4.0/3.7, and > or = 4.0/3.7 g/dl. RESULTS Of 675 adolescents, 557 were hospitalized and 50 died. Albumin > or = 4.0/3.7 g/dl was associated with male gender, Hispanic ethnicity, and higher hemoglobin level. Those with albumin > or = 4.0/3.7 g/dl had fewer deaths per 100 patient-years and fewer hospitalizations per time at risk. In multivariate analysis, patients with albumin > or = 4.0/3.7 g/dl had 57% decreased risk for death. Poisson regression showed progressive decrease in hospitalization risk as albumin level increased; however, confidence intervals were similar between albumin > or = 4.0/3.7 g/dl and albumin > or = 3.5/3.2 and < 4.0/3.7 g/dl. CONCLUSIONS This study demonstrates decreased mortality and hospitalization risk with albumin > or = 3.5/3.2 g/dl and suggests that adolescent hemodialysis patients who are able to achieve serum albumin > or = 4.0/3.7 g/dl may have the lowest mortality risk.
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Affiliation(s)
- Sandra Amaral
- Emory University School of Medicine, Department of Pediatrics, 2015 Uppergate Drive NE, Atlanta, GA 30322, USA.
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