Association of Individual- and Neighborhood-Level Social Determinants of Health with Post-Hospitalization Acute Kidney Injury Care

Key Points Only one third of intensive care unit patients who developed severe AKI received Kidney Disease Improving Global Outcomes–recommended follow-up care within 3 months of AKI. Both individual-level and neighborhood-level socioeconomic disadvantages are associated with decreased post-AKI follow-up care. Background Individual-level and neighborhood-level social determinants of health (SDOH) measures have been associated with higher incidence of AKI, lower likelihood of recovery, and higher risk of mortality after AKI. The association of SDOH measures with posthospitalization AKI follow-up care is unknown. Methods Using a retrospective cohort design, we evaluated the association of individual-level (insurance status, race, ethnicity) and neighborhood-level (socioeconomic deprivation, rurality, residential segregation, and social vulnerability to natural or human-caused disasters) SDOH measures with receipt of posthospitalization follow-up for AKI within 3 months of hospital discharge among intensive care unit (ICU) survivors with AKI stage 2 or 3 hospitalized between 2012 and 2023 at a major academic medical center. The primary outcome, posthospitalization AKI follow-up, was defined as the occurrence of at least one of the following within 3 months of hospital discharge: a nephrology outpatient visit, serum creatinine measurement, or urine protein measurement. We used pooled logistic regression models with inverse probability of censoring weighting to adjust for demographics, comorbidities, and hospitalization characteristics and to account for the competing risks of death, rehospitalization, or dialysis initiation. Results Among 13,392 adult ICU survivors with AKI stages 2 or 3, 5970 (45%) were female, 4488 (34%) were of Black race, and 1561 (12%) were uninsured. A total of 7316 (61%) received posthospitalization follow-up for AKI within 3 months of hospital discharge. Uninsured individuals (adjusted odds ratio [aOR], 0.77; 95% confidence interval [CI], 0.70 to 0.84), individuals residing in a neighborhood with greater socioeconomic deprivation (aOR, 0.86; 95% CI, 0.81 to 0.92), greater rurality (aOR, 0.86; 95% CI, 0.81 to 0.92), greater segregation (aOR, 0.92; 95% CI, 0.87 to 0.98), and greater social vulnerability (aOR, 0.83; 95% CI, 0.77 to 0.89) all experienced significantly lower odds of posthospitalization AKI care. Conclusions Both individual-level and neighborhood-level SDOH were associated with lower odds of post-AKI follow-up among ICU survivors with severe AKI.