Journal
BMC NEPHROLOGY
Volume 15, Issue -, Pages -Publisher
BIOMED CENTRAL LTD
DOI: 10.1186/1471-2369-15-192
Keywords
ESRD; Chronic kidney disease; Socioeconomic status; Disparity; Geospatial
Categories
Funding
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Service [U01 NS041588]
- Harold Amos Medical Faculty Development Program of the Robert Wood Johnson Foundation, Princeton, NJ
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Bethesda, MD [K23DK097184]
- Gilbert S. Omenn Anniversary Fellowship of the Institute of Medicine
- NIDDK [R01 DK78124]
- Open Access Promotion Fund of the Johns Hopkins University Libraries
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Background: The risk of end stage renal disease (ESRD) is increased among individuals with low income and in low income communities. However, few studies have examined the relation of both individual and community socioeconomic status (SES) with incident ESRD. Methods: Among 23,314 U.S. adults in the population-based Reasons for Geographic and Racial Differences in Stroke study, we assessed participant differences across geospatially-linked categories of county poverty [outlier poverty, extremely high poverty, very high poverty, high poverty, neither (reference), high affluence and outlier affluence]. Multivariable Cox proportional hazards models were used to examine associations of annual household income and geospatially-linked county poverty measures with incident ESRD, while accounting for death as a competing event using the Fine and Gray method. Results: There were 158 ESRD cases during follow-up. Incident ESRD rates were 178.8 per 100,000 person-years (10(5) py) in high poverty outlier counties and were 76.3 / 10(5) py in affluent outlier counties, p trend = 0.06. In unadjusted competing risk models, persons residing in high poverty outlier counties had higher incidence of ESRD (which was not statistically significant) when compared to those persons residing in counties with neither high poverty nor affluence [hazard ratio (HR) 1.54, 95% Confidence Interval (CI) 0.75-3.20]. This association was markedly attenuated following adjustment for socio-demographic factors (age, sex, race, education, and income); HR 0.96, 95% CI 0.46-2.00. However, in the same adjusted model, income was independently associated with risk of ESRD [HR 3.75, 95% CI 1.62-8.64, comparing the < $20,000 income group to the > $75,000 group]. There were no statistically significant associations of county measures of poverty with incident ESRD, and no evidence of effect modification. Conclusions: In contrast to annual family income, geospatially-linked measures of county poverty have little relation with risk of ESRD. Efforts to mitigate socioeconomic disparities in kidney disease may be best appropriated at the individual level.
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