Incidence and Predictors of End Stage Renal Disease among Low-Income Blacks and Whites

Abstract

We evaluated whether black race is associated with higher incidence of End Stage Renal Disease (ESRD) among a cohort of blacks and whites of similar, generally low socioeconomic status, and whether risk factor patterns differ among blacks and whites and explain the poorly understood racial disparity in ESRD. Incident diagnoses of ESRD among 79,943 black and white participants in the Southern Community Cohort Study (SCCS) were ascertained by linkage with the United States Renal Data System (USRDS) from 2002 through 2009. Person-years of follow up were calculated from date of entry into the SCCS until date of ESRD diagnosis, date of death, or September 1, 2009, whichever occurred first. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for incident ESRD among black and white participants in relation to baseline characteristics. After 329,003 person-years of follow-up, 687 incident cases of ESRD were identified in the cohort. The age-adjusted ESRD incidence rate was 273 (per 100,000) among blacks, 3.5-fold higher than the rate of 78 among whites. Risk factors for ESRD included male sex (HR = 1.6; 95% CI 1.4–1.9), low income (HR = 1.5; 95% CI 1.2–1.8 for income below vs. above $15,000), smoking (HR = 1.2; 95% CI 1.02–1.4) and histories of diabetes (HRs increasing to 9.4 (95% CI 7.4–11.9) among those with ≥20 years diabetes duration) and hypertension (HR = 2.9; 95% CI 2.3–3.7). Patterns and magnitudes of association were virtually identical among blacks and whites. After adjustment for these risk factors, blacks continued to have a higher risk for ESRD (HR = 2.4; 95% CI = 1.9–3.0) relative to whites. The black-white disparity in risk of ESRD was attenuated but not eliminated after control for known risk factors in a closely socioeconomically matched cohort. Further research characterizing biomedical factors, including CKD progression, in ESRD occurrence in these two racial groups is needed.

Disparities in Electronic Health Record Patient Portal Use in Nephrology Clinics

“…Covariates for adjustment were chosen according to clinical significance and possible effect on portal adoption (1,(3)(4)(5)(6)(7)(8)10,11,(13)(14)(15)29,31,33,34,36,(54)(55)(56)(57)(58)(59)(60)(61)(62)(63). Sociodemographic variables were age, sex, race, marital status, insurance status, neighborhood median household income, tobacco use, and follow-up duration.…”

“…We sought to address this gap by examining portal use, including secular trends, in universityaffiliated general nephrology clinics. Given previous literature indicating that underserved groups are less likely to use EHR portals (32)(33)(34)(35)(36), we hypothesized that race, neighborhood median household income, and insurance status would be associated with portal use and of particular concern in view of documented CKD disparities in these groups (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). In addition, we believed that BP control, a key modifiable outcome that affects CKD progression, would depend on patient adherence, self-monitoring, and patient-provider communication.…”

“…CKD contributes to substantial morbidity and mortality, particularly among vulnerable populations (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Patient activation (the "knowledge, skills and confidence" needed to actively engage in care) (12) is a critical feature of CKD management, wherein BP self-monitoring, dietary modification, medication adherence, nephrotoxin avoidance, and patient-provider collaboration are essential (13)(14)(15)(16).…”

Diagnosis and Surgical Delays in African American and White Women with Early-Stage Breast Cancer

“…16 Epidemiologic research in other diseases has found that stratifying analysis by race allows exploration of between-race and within-race differences in risk factors of interest. [17][18][19][20] We utilized detailed medical-record and interview data on a large sample of AA and white women with early-stage BC who participated in the Breast Cancer Treatment Disparity Study (BCTDS). The study aims to examine whether racial differences exist in delay from symptom recognition to diagnosis and surgery and to determine the factors that predict delay for AAs and whites.…”

Role of socioeconomic disparities in incidence and mortality of chronic kidney disease

“…Martins et al studied the relationship between microalbuminuria and macroalbuminuria and the individual economic and social situation in the United States of America, so that the odds ratio of microalbuminuria in the poor (defined as less than 200% federal poverty level) was equal to 1.35; 95% confidence interval (CI): 1.22-1.49 and for macroalbuminuria was equal to 1.78; 95% CI: 1.40-2.26 compared to other people. According to another study by Lipworth et al, the risk of end-stage renal disease (ESRD) in people with the income level of less than or equal to $15000 per year was 50% more than others (Lipworth et al, 2012). Risk of ESRD incidence in homeless people was also more than those who lived in houses.…”