Association of Individual- and Neighborhood-Level Social Determinants of Health with Post-Hospitalization Acute Kidney Injury Care
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".