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Home > Social Determinants of Health and Kidney Disease > Social and Environmental Determinants of Health and Chronic Kidney Disease > County-Level Residential Segregation (Black/White) and Prevalence of Diagnosed CKD, U.S. Medicare Population 2019

County-Level Residential Segregation (Black/White) and Prevalence of Diagnosed CKD, U.S. Medicare Population 2019

County-Level Residential Segregation (Black/White) and Prevalence of Diagnosed CKD, U.S. Medicare Population 2019

The bivariate map shows the intersection between residential segregation index (Black/White) and the prevalence of diagnosed CKD among Medicare enrollees. In 2019, the mean residential segregation index was 49.7 (SD=16.6) and the prevalence of Medicare enrollees with diagnosed CKD was 22.1% (SD=6.5, N=3,097), with large variation across counties. The residential segregation index and the prevalence of CKD are high in counties in Pennsylvania and the Midwest region in the United States (Ohio, Michigan, and Wisconsin).

Data Source: CMS & CHR
Percentage of the population under the poverty level, by county (2018)
State: 
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Tertile breaks are used to create categories using all data (a break created at the 33rd and 66th percentiles for the three-by-three map). Definitions for low, mid, and high are displayed below. The county-level residential segregation index (Black/White) ranged from 2.2 to 94.9 and the county-level percentage of diagnosed CKD patients among the Medicare population ranged from 0% to 57.1%. Data are not adjusted.

Residential segregation index (Black/White) - Low: <42.3; Mid: 42.3 to 57.5; High >57.5

Patients with diagnosed CKD - Low: <20.5%; Mid: 20.5% to 25.0%; High: >25%

The residential segregation index is developed by the County Health Ranking using American Community Survey 5-year estimate data (2017–2021) to assess residential segregation of Black and White residents.

CMS maintains claims data on beneficiaries aged 65 years and older, those with disabilities, and those with end-stage kidney disease. A 5% random sample of beneficiaries who had at least one inpatient or outpatient visit during the calendar year—over 1.8 million annually—of Medicare claims data was used. Diagnoses for medical conditions in Medicare data come from claims submitted by providers for Medicare fee-for-service Part A (hospital insurance) and Part B (medical insurance). The analysis sample was limited to beneficiaries aged 65 years or older who had Parts A and B coverage for the entire calendar year and had at least one inpatient or outpatient visit in that calendar year. Between 20% and 37% of beneficiaries each year used Part C (managed care/Medicare Advantage plans) and are excluded because their care was paid on a fixed amount and claims with diagnoses are unavailable. Chronic kidney disease, diabetes, and hypertension are defined by at least one diagnosis code for each condition.

FieldData
Description of Measure

Spatial distribution of Black/White racial segregation and diagnosed CKD in the U.S. Medicare population at county-level.

Data Set

Medicare 5% random sample and the County Health Ranking using American Community Survey 5-year estimate data to assess residential segregation of Black and White residents.

Population

Medicare fee-for-service beneficiaries aged ≥ 65 years and U.S. Counties.

Years Included

2019.

Numerator

Medicare fee-for-service beneficiaries aged ≥ 65 years with diagnosed CKD from claims by any of the ICD-9-CM or ICD-10-CM CKD codes listed below. Beneficiaries with ESRD were excluded.

Denominator

Medicare fee-for-service beneficiaries aged ≥ 65 years with full-year Parts A and B enrollment and at least one inpatient or outpatient visit in the given calendar year.

Definition of CKD

ICD-9-CM and ICD-10-CM diagnosis codes.

ICD-10-CM Codes for CKD

A18.11, A52.75, B52.0, C64.x, C68.9, D30.0x, D41.0x-D41.2x, D59.3, E08.2x, E09.2x, E10.2x, E10.65, E11.2x, E11.65, E13.2x, E74.8, I12.xx, I13.0, I13.1x, I13.2, K76.7, M10.3x, M32.14, M32.15, N01.x-N08.x, N13.1, N13.1x-N13.39, N14.x,N15.0, N15.8, N15.9, N16, N17.x, N18.1-N18.5, N18.8, N18.9, N19, N25.xx, N26.1, N26.9, O10.4xx, O12.xx, O26.83x, O90.89, Q61.02, Q61.1x-Q61.8, Q26.0-Q26.39, R94.4
(x and xx stand for all the codes within the main diagnosis).

ICD-9-CM Codes for CKD

016.0, 095.4, 189.0,189.1, 189.9, 236.91, 250.4, 250.41, 250.42, 250.43, 271.4, 274.10, 283.11, 403.xx, 404.xx, 405.01, 405.11, 440.1, 442.1, 447.3, 453.3, 573.4, 580.xx, 581.xx, 582.xx, 583.xx, 584.5, 585.x, 587.xx, 588.xx, 590.xx, 591, 592.x, 593.xx, 642.1, 646.2, 753.xx, 794.4.

Limitations of Indicator

As a measure of prevalence, the use of ICD-9-CM or ICD-10-CM diagnosis codes will likely underestimate CKD.

Analytical Considerations

Counties with 10 or fewer Medicare beneficiaries have been suppressed to protect against potential identification of individuals.