280 - Urbanicity and Rurality Among 2019 Pediatric Chronic Kidney Disease Hospitalizations in the United States: Exploring Opportunities to Improve Healthcare Access

Background:  Chronic kidney disease (CKD) can lead to costly and burdensome hospitalizations for children and adolescents. Children and adolescents in rural areas may face unique barriers to accessing care due to the centralization of definitive pediatric inpatient and pediatric nephrology care primarily at urban, academic medical centers.

Objective:

Objective:  The aims of this study are to 1) describe patient and hospital characteristics of pediatric CKD hospitalizations by urbanicity/rurality of patient residence and 2) to compare differences in inter-hospital transfer and mortality by urbanicity/rurality.

Design/Methods:

Design/Methods:  This study used Kids’ Inpatient Database, an all-payer claims dataset sampled to represent all 2019 pediatric (0-21 years) hospitalizations in the US. Hospitalizations containing a diagnosis code for CKD in any position were included. Neonates and patients missing rurality variable were excluded. The National Center for Health Statistics definition classified rurality based on patient county of residence. Analyses incorporated the complex survey design using weighted logistic regression incorporating survey cluster, strata, weights, and domain. Covariates included age, race/ethnicity, sex, pediatric-specific co-morbidities, and county-level income.

Results:

Results:  56,727 pediatric hospitalizations were identified. Patient residence was 32.4% central metro (urban), 24.4% fringe metro (suburban), 29.5% other metro (medium and small metro), and 13.1% rural (micropolitan and non-metropolitan). Urban, med/small metro, and rural groups had fewer patients from highest income quartiles (20.9, 9.7%, and 1.2% respectively) compared to suburban (38.4%) areas (p< 0.001). Over 96% of CKD-related hospitalizations were in urban teaching hospitals. Risk factors for hospitalization at a rural hospital included rural residence, age 17-21 years, and male sex. After adjustment, the odds of inter-hospital transfer from another acute care hospital were higher among hospitalizations of patients from rural areas (aOR: 1.62, 95%CI 1.10 to 2.38) (Figure 1). There were no differences in mortality by rurality/urbanicity.

Conclusion(s):

Conclusions:  About one in three US pediatric CKD hospitalizations are of urban patients and one in ten hospitalizations are of rural patients. Rural patients are more likely to be hospitalized in rural hospitals, especially at older ages when they also may be undergoing a care transition from pediatric to adult nephrology care. This study underscores the need to further assess the impact of rurality and urbanicity on CKD progression and healthcare utilization.