Table 3.

Characteristics of patients with diabetes using in-center hemodialysis with a care gap score above and below the median as of January 1, 2018

CharacteristicsGap Score >1 (N=1775)Gap Score ≤1 (N=2398)Standardized Difference
Age
 Mean±SD, yr66.83±14.267.54±12.310.05
 Median (IQR), yr68.00 (57.00–77.00)68.00 (59.00–77.00)0.02
 18–49 yr, n (%)213 (12)200 (8)0.12
 50–65 yr, n (%)541 (31)767 (32)0.03
 66–74 yr, n (%)430 (24)697 (29)0.11
 ≥75 yr, n (%)591 (33)734 (31)0.06
Female sex, n (%)742 (42)885 (37)0.1
Race, n (%)
 White1050 (59)1351 (56)0.06
 Black192 (11)246 (10)0.02
 Other526 (30)794 (33)0.07
 Missing7 (0.4)7 (0.3)0.02
Rostered to family doctor, n (%)
 0 (not rostered)153 (9)140 (6)0.11
 1 (rostered)1361 (77)1841 (77)0
 2 (virtually rostered)261 (15)417 (17)0.07
Income quintile, n (%) a
 1 (lowest)577 (33)785 (33)0
 2427 (24)554 (23)0.02
 3326 (18)446 (19)0.01
 4238 (13)350 (15)0.03
 5 (highest)207 (12)263 (11)0.02
Distance to dialysis center (km)
 Mean±SD17.85±49.919.63±72.920.03
 Median (IQR)6.53 (3.21–13.87)6.21 (3.28–12.57)0.03
Marginalization index, n (%)
 Instability quintile
  1 (lowest instability) 265 (15)361 (15)0
  2 269 (15)326 (14)0.04
  3 308 (17)380 (16)0.04
  4 348 (20)471 (20)0
  5 (highest instability) 552 (31)807 (34)0.05
  Missing 33 (2)53 (2)0.02
 Deprivation quintile
  1 (lowest deprivation) 218 (12)315 (13)0.03
  2 274 (15)383 (16)0.01
  3 306 (17)418 (17)0.01
  4 405 (23)518 (22)0.03
  5 (highest deprivation) 539 (30)711 (30)0.02
  Missing 33 (2)53 (2)0.02
 Dependency quintile
  1 (lowest dependency) 338 (19)470 (20)0.01
  2 311 (18)405 (17)0.02
  3 279 (16)417 (17)0.04
  4 330 (19)420 (18)0.03
  5 (highest dependency) 484 (27)633 (26)0.02
  Missing 33 (2)53 (2)0.02
 Ethnic concentration quintile
  1 (lowest concentration) 273 (15)359 (15)0.01
  2 269 (15)352 (15)0.01
  3 290 (16)362 (15)0.03
  4 311 (18)447 (19)0.03
  5 (highest concentration) 599 (34)825 (34)0.01
  Missing 33 (2)53 (2)0.02
Long-term care, n (%)131 (7)132 (6)0.08
Lives in rural locationa 204 (12)242 (10)0.05
Duration of diabetes, yr
 Mean±SD16.5±7.718.4±7.00.26
 Median (IQR)17.2 (10.2–23.9)20.0 (13.7–24.8)0.24
Comorbidities
 COPD, n (%)539 (30)736 (31)0.01
 CHF, n (%)930 (52)1368 (57)0.09
 Dementia, n (%)169 (10)210 (9)0.03
 CAD, n (%)1016 (57)1579 (66)0.18
 Stroke, n (%)225 (13)358 (15)0.07
 Foot ulcer, n (%)163 (9)326 (14)0.14
 Amputation, n (%)95 (5)199 (8)0.12
 Depression and anxiety, n (%)158 (9)216 (9)0
 Hypoglycemia, n (%)209 (12)263 (11)0.03
 Hyperglycemia, n (%)9 (0.5)9 (0.4)0.02
 Retinopathy, n (%)118 (7)355 (15)0.27
 Cancer, n (%)238 (13)380 (16)0.07
 Liver, n (%)242 (14)366 (15)0.05
 Charlson score
  Mean±SD 4.8±2.05.1±1.90.15
  Median (IQR) 5.0 (4.0–6.0)5.0 (4.0–6.0)0.15
  0, n (%) 16 (0.9)11 (0.5)0.05
  1, n (%) 8 (0.5)18 (0.8)0.04
  2, n (%) 223 (13)190 (8)0.15
  3, n (%) 126 (7)142 (6)0.05
  ≥4, n (%) 1344 (76)2019 (84)0.21
  Missing, n (%) 58 (3)18 (0.8)0.18
Healthcare utilization in the prior year
 Number of specialist visitsb
  Mean±SD 13.5±12.120.1±14.70.48
  Median (IQR) 11.0 (5.0–19.0)17.0 (10.0–27.0)0.55
  0, n (%) 116 (7)19 (0.8)0.31
  1–2, n (%) 152 (9)70 (3)0.24
  3–5, n (%) 258 (15)192 (8)0.21
  6–11, n (%) 422 (24)463 (19)0.11
  ≥12, n (%) 827 (47)1654 (69)0.47
 Number of primary care visits
  Mean±SD 8.1±12.48.7±11.50.06
  Median (IQR) 5.0 (2.0–11.0)6.0 (2.0–11.0)0.13
  0, n (%) 261 (15)263 (11)0.11
  1–2, n (%) 311 (18)376 (16)0.05
  3–5, n (%) 366 (21)476 (20)0.02
  ≥6, n (%) 837 (47)1283 (54)0.13
 At least one diabetes visit, n (%)c 865 (49)1484 (62)0.27
 Number of diabetes visitsc
  Mean±SD 2.3±4.32.9±4.40.13
  Median (IQR) 0.0 (0.0–3.0)1.0 (0.0–4.0)0.24
  0, n (%) 910 (51)914 (38)0.27
  1–2, n (%) 311 (18)528 (22)0.11
  3–5, n (%) 294 (17)523 (22)0.13
  ≥6, n (%) 260 (15)433 (18)0.09
 Physician seen for diabetes, n (%)
  General practitioner 496 (28)795 (33)0.11
  Internal medicine 112 (6)214 (9)0.1
  Endocrinology 248(14)456 (19)0.14
  Other ≤5≤50.01
  No visits 910 (51)914 (38)0.27
 Number of unique physician visits
  Mean±SD 35.5±25.241.0±24.50.22
  Median (IQR) 29.0 (17.0–48.0)36.0 (23.0–53.0)0.29
 All cause ED visits
  Mean±SD 3.2±5.63.1±4.50.02
  Median (IQR) 2.0 (0.0–4.0)2.0 (1.0–4.0)0.02
 All cause hospitalization
  Mean±SD 2.9±3.23.3±3.00.15
  Median (IQR) 2.0 (1.0–4.0)3.0 (1.0–5.0)0.23
Laboratory tests
 At least one HbA1c, n (%)1272 (72)2182 (91)0.51
 HbA1c value
  Mean±SD, % 6.8±1.66.9±1.60.08
  Median (IQR), % 6.5 (5.6–7.7)6.6 (5.8–7.8)0.11
  ≤7%, n (%) 820 (46)1316 (55)0.17
  >7%, n (%) 452 (26)866 (36)0.23
  Missing, n (%) 503 (28)216 (9)0.51
  • Cell sizes of less than six were suppressed for patient privacy, as per ICES privacy policies. IQR, interquartile range; COPD, chronic obstructive pulmonary disorder; CHF, congestive heart failure; CAD, coronary artery disease; HbA1c, hemoglobin A1c.

  • a Fewer than 3% of patients had missing data. To avoid small cells from being recalculated, missing income quintiles was recoded as “3.” Missing rural was also recoded as “no” (urban).

  • b Selected specialties in “specialist visits” included: dermatology, dermatology, general surgery, neurosurgery, community medicine, orthopedic surgery, geriatrics, plastic surgery, cardiothoracic surgery, emergency medicine, internal medicine, endocrinology, nephrology, vascular surgery, neurology, psychiatry, obstetrics and gynecology, genetics, ophthalmology, otolaryngology, physical medicine, urology, gastroenterology, medical oncology, infectious disease, respiratory disease, rheumatology, optometrists, osteopaths, chiropodists, chiropractor, cardiology, hematology, clinical immunology, nuclear medicine, and thoracic surgery.

  • c Physicians seen for “diabetes visits” included internists, nephrologists, endocrinologists, general practitioners, and geriatricians.