PUK21 RACIAL DISPARITIES IN RECORDING ANEMIA AS A COMPLICATION AMONG END-STAGE RENAL DISEASE PATIENTS

Anemia is a modifiable complication of end-stage renal disease (ESRD) associated with morbidity and mortality. Despite a changing policy context that may affect anemia management, there is a paucity of research regarding disparities in anemia outcomes among ESRD patients in the USA. This study examines racial disparities among ESRD patients related to anemia and assesses the impact of the Medicare ESRD Prospective Payment System (PPS) and Affordable Care Act (ACA) on anemia outcomes. We examined the risk of being diagnosed with anemia among ESRD patients using the hospital inpatient database HCUP-NIS from 2008 to 2015. ICD-9-CM and ICD-10-CM diagnostic and procedure codes were used to identify ESRD patients, anemia due to chronic kidney disease and generate Deyo-Charlson comorbidity index. Linear splines and multivariable logistic regression were used to examine racial disparities in respect of diagnosed anemia, adjusted for individual and hospital characteristics. Difference-in-difference analyses were used to examine the impact of PPS and ACA polices respectively. Models were weighted for ACA exposure. In analyses that pooled observations across 8 years, the proportion of anemia arising from CKD cases increased from 25.7% in 2008 to 43.9% in 2015.The likelihoods of having anemia in Black, Asian, Hispanic and Native Americans were significantly higher than Whites after adjustment for covariates, OR 1.03 (95%CI: 1.00-1.05), 1.23 (1.17-1.29), 1.14 (1.10-1.17) and 1.32 (1.19-1.45), respectively. The odds of being diagnosed with anemia increased 38% (95%CI 36%-41%) after PPS. Difference-in-difference analysis revealed that for Black, Asian, Hispanic and Native Americans, disparities widened in the wake of PPS though the degree of widening attenuated following ACA. We found a significant racial disparity in the recording of anemia as a complication among ESRD patients. The PPS and ACA policies appear to have driven an increase in recording of anemia but these policies exerted differential impacts on anemia-related racial disparities.