TY - JOUR
T1 - Sex Differences in Health Care Utilization, End-Stage Renal Disease, and Mortality Among Medicaid Beneficiaries With Incident Lupus Nephritis
AU - Feldman, Candace H.
AU - Broder, Anna
AU - Guan, Hongshu
AU - Yazdany, Jinoos
AU - Costenbader, Karen H.
N1 - Funding Information:
Supported by the NIH (National Institute of Arthritis and Musculoskeletal and Skin Diseases grants K23-AR-071500 to Dr. Feldman, K23-AR-068441 to Dr. Broder, and R01-057327 and K24-AR-066109 to Dr. Costenbader), the Centers for Disease Control and Prevention (grant U01DP005120 to Dr. Yazdany), and the Rheumatology Research Foundation (Investigator Award to Dr. Feldman).
Publisher Copyright:
© 2017, American College of Rheumatology
PY - 2018/3
Y1 - 2018/3
N2 - Objective: While systemic lupus erythematosus and lupus nephritis (LN) disproportionately affect females, previous studies suggest that males may experience poorer outcomes. We undertook this study to investigate sex differences in health care utilization, end-stage renal disease (ESRD), and mortality among patients with LN receiving Medicaid, public insurance for low-income individuals. Methods: Within the Medicaid Analytic eXtract (MAX) from 29 states (from 2000 to 2010), we used billing claims to identify individuals ages 5–65 years with incident LN (positive predictive value 80%). MAX data were linked to the US Renal Data System to determine ESRD and to Social Security Death Index files to determine death. We estimated adjusted incidence rate ratios (IRRs) by sex for health care utilization using Poisson regression, and we used multivariable proportional hazards models to compare risks of ESRD and death by sex. Results: Of 2,750 patients with incident LN, 283 (10%) were male. The mean ± SD follow-up period for both sexes was 3.1 ± 2.3 years. The mean ± SD age was 29.6 ± 13.9 years among females and 24.7 ± 14.1 years among males (P < 0.01). Males had fewer outpatient visits (IRR 0.88 [95% confidence interval (95% CI) 0.80–0.97]) and fewer emergency department visits (IRR 0.75 [95% CI 0.63–0.90]). The 5-year cumulative incidence of ESRD was 22.3% in males and 21.2% in females. The 5-year cumulative incidence of death was 9.4% in males and 9.8% in females. Comparing males to females, there were no sex differences in ESRD (subdistribution hazard ratio [HR] 1.05 [95% CI 0.76–1.45]) or death (HR 0.81 [95% CI 0.47–1.35]). Conclusion: In this cohort of patients with incident LN, ESRD and mortality were extremely high overall but were not increased among males compared to females. In this vulnerable population, biologic and health care utilization differences by sex may not significantly affect outcomes.
AB - Objective: While systemic lupus erythematosus and lupus nephritis (LN) disproportionately affect females, previous studies suggest that males may experience poorer outcomes. We undertook this study to investigate sex differences in health care utilization, end-stage renal disease (ESRD), and mortality among patients with LN receiving Medicaid, public insurance for low-income individuals. Methods: Within the Medicaid Analytic eXtract (MAX) from 29 states (from 2000 to 2010), we used billing claims to identify individuals ages 5–65 years with incident LN (positive predictive value 80%). MAX data were linked to the US Renal Data System to determine ESRD and to Social Security Death Index files to determine death. We estimated adjusted incidence rate ratios (IRRs) by sex for health care utilization using Poisson regression, and we used multivariable proportional hazards models to compare risks of ESRD and death by sex. Results: Of 2,750 patients with incident LN, 283 (10%) were male. The mean ± SD follow-up period for both sexes was 3.1 ± 2.3 years. The mean ± SD age was 29.6 ± 13.9 years among females and 24.7 ± 14.1 years among males (P < 0.01). Males had fewer outpatient visits (IRR 0.88 [95% confidence interval (95% CI) 0.80–0.97]) and fewer emergency department visits (IRR 0.75 [95% CI 0.63–0.90]). The 5-year cumulative incidence of ESRD was 22.3% in males and 21.2% in females. The 5-year cumulative incidence of death was 9.4% in males and 9.8% in females. Comparing males to females, there were no sex differences in ESRD (subdistribution hazard ratio [HR] 1.05 [95% CI 0.76–1.45]) or death (HR 0.81 [95% CI 0.47–1.35]). Conclusion: In this cohort of patients with incident LN, ESRD and mortality were extremely high overall but were not increased among males compared to females. In this vulnerable population, biologic and health care utilization differences by sex may not significantly affect outcomes.
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U2 - 10.1002/art.40392
DO - 10.1002/art.40392
M3 - Article
C2 - 29193893
AN - SCOPUS:85041592215
SN - 2326-5191
VL - 70
SP - 417
EP - 426
JO - Arthritis and Rheumatology
JF - Arthritis and Rheumatology
IS - 3
ER -