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Home > Social Determinants of Health and Kidney Disease > Social and Environmental Determinants of Health and Chronic Kidney Disease > U.S. Population Below the Poverty Threshold Level and CKD in the U.S. Medicare Population, by County

U.S. Population Below the Poverty Threshold Level and CKD in the U.S. Medicare Population, by County

U.S. Population Below the Poverty Threshold Level and CKD in the U.S. Medicare Population, by County

The map shows the overlap of the county-level (n=3,097) percentage of the population below the poverty threshold from the American Communities Survey and the county-level percentage of patients with diagnosed chronic kidney disease (CKD) among the Medicare population. Geographic variation is observed in the county-level percentage of the population below the poverty threshold (mean=15.4%) and the county-level percentage of diagnosed CKD patients among the Medicare population (mean=22.1%). The percentage of the population under the poverty level and the prevalence of CKD are high in counties in the Southern region.

Data Source: CMS & ACS
Percentage of the population under the poverty level, by county (2018)
State: 
County: 
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Tertiles were used for both variables to create three equally sized groups for display on the map. Definitions for low, mid, and high are displayed below. The county-level percentage of the population below the poverty threshold ranged from 2.8% to 63.2% and the county-level percentage of diagnosed CKD patients among the Medicare population ranged from 0% to 57.1%. Data are not adjusted.

Population below the poverty threshold - Low: <12%; Mid:12% to 17%; High: >17%

Patients with diagnosed CKD - Low: <20%; Mid: 20% to 24%; High: >24%

The American Community Survey (ACS) collects information about the nation and its residents on a yearly basis to help determine how federal and state funds are spent. The ACS provides publicly available data on jobs and occupations, educational attainment, Veteran status, whether people own or rent their homes, and other topics. Data on poverty thresholds for 2015–2019 were taken from the Current Population Survey. Poverty thresholds are calculated by family size and composition.

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 Indicator

County and state estimates of diagnosed CKD among Medicare Beneficiaries aged ≥ 65 years.

Dataset

Medicare 5% random sample.

Population

Medicare fee-for-service beneficiaries aged ≥ 65 years.

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.

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.

Diabetes

Diabetes is determined by the presence of an ICD-9-CM code (250.xx, 357.2, 336.41, 362.01, 362.02) or ICD-10-CM (E08.xx, E09.xx, E10.xx, E11.xx, E13.xx) on at least one claim during the given calendar year.

Hypertension

Hypertension is determined by the presence of an ICD-9-CM code (401.x through 405.x) or ICD-10-CM code (H35.03x, I10.xx, I11.xx, I12.xx, I13.xx, I15.xxx, I67.4, N26.2) on at least one claim during the given calendar year.

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 beneficiaries have been suppressed to protect potential identification of individuals.