The Association of Poverty With the Prevalence of Albuminuria: Data From the Third National Health and Nutrition Examination Survey (NHANES III)

Abstract

Background-Albuminuria is a major risk factor for the development and progression of chronic kidney disease (CKD) and cardiovascular disease. Socioeconomic factors also have been reported to modify CKD and cardiovascular risk factors and clinical outcomes. The extent to which poverty influences the prevalence of albuminuria, particularly among racial/ethnic minority populations, is not well established. The influence of poverty on the prevalence of albuminuria and the implication of this relationship for the racial and/or ethnic differences in the prevalence of albuminuria were examined.

Disparities in Electronic Health Record Patient Portal Use in Nephrology Clinics

“…These findings comport with earlier studies in non-nephrology settings (32)(33)(34)(35)(36). While the increase in portal adoption across groups in more recent years suggests progress, the continued differences in portal adoption among nephrology patients are disquieting because socioeconomic and racial disparities in CKD outcomes are well documented (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Disparities in the use of patient portals and emerging e-health technologies may reinforce or widen extant disparities.…”

“…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).…”

Preeclampsia and Subsequent Cardiovascular Disease

“…The control group had significantly lower household income and tended to be less educated than women in the preeclampsia group, and low socioeconomic status is associated with microalbuminuria (19). Compared with population averages, study controls were significantly older at the time of first birth, and had a higher rate of low birthweight offspring, variables that are potentially associated with microalbuminuria (12,20).…”