(B) Description of Concurrent CKD and HF by Race and Ethnicity Distribution in the US

Publication Number: 1001

Background: Increasing the representativeness of clinical trials to improve generalizability has become important to health authorities. Current publications comparing statistics on disparity, measured as Race Ethnicity & Minorities (REMs), have indicated long term inequity across clinical trial inclusion rates. To mediate clinical trial inclusion rates, disease specific Real World Data (RWD) estimates by REMs categories, are required. While more research has been conducted on Heart Failure (HF) and Chronic Kidney Disease (CKD) separately, few studies have assessed the distribution of concurrent CKD and HF by REMs and sex in RWD.

Objectives: To describe variation across racial and ethnic groups among patients with concurrent CKD and HF.

Methods: The TriNetX (USA) electronic medical records (EMR) network from 2005 to February 2022 was used to retrieve REMs counts for patients in the US with HF and CKD concurrently. ICD-9 and ICD-10 codes were used to identify subjects for CKD and HF diagnoses. TriNetX is broadly representative of the US population and captures 54,909,750 US subjects with REMs data. The REMs categories are recorded according to Health Level 7 (HL7) including not Hispanic White, Black, Asian, American Indian or Alaska Native, and Native Hawaiian or Other Pacific Islander subgroups; along with Hispanic ethnicity (all races).

Results: In TriNetX, patients with concurrent CKD and HF was 895,900. Patients of Black not Hispanic background represented 22.3% of the population, White not Hispanic 66.9% and Hispanic 8.6%. The distribution for other smaller REMs categories was < 5%. When further stratifying by sex we found a greater burden of concurrent CKD and HF in men compared to women across all REMs. The highest prevalence was found in Asian not Hispanic males (58.7%).

For comparative purposes we also assessed CKD and HF separately by REMs. The Black not Hispanic population with HF constituted 15.3% and for CKD 20.3%. Hispanics represented for CKD 9.9% and HF 8.3%, while White not Hispanic CKD 67.0% and HF 74.1%. The remaining ethnic and racial groups were < 2% for both.

Of import, the Black not Hispanic group represented a greater proportion among those with CKD, HF, or both in comparison to the US Census 2020 (12.1%). In contrast, the Hispanic group consisted of a lower proportion compared to the US Census (18.7%).

Conclusions: The investigation of REMs disparities may reflect socioeconomic or genetic influences. Concurrent CKD and HF was consistently higher in men than women across all REMs. Regardless of sex, Black not Hispanics had the highest prevalence. These descriptive data for concurrent CKD and HF illustrate the importance of considering social subgroup characteristics to better understand disease epidemiology.