Dataset Information

Racial disparities in end-stage renal disease in a high-risk population: the Southern Community Cohort Study.

ABSTRACT:

Introduction

The Southern Community Cohort Study is a prospective study of low socioeconomic status (SES) blacks and whites from the southeastern US, where the burden of end-stage renal disease (ESRD) and its risk factors are high. We tested whether the 2.4-fold elevated risk of ESRD we previously observed in blacks compared to whites was explained by differences in baseline kidney function.

Methods

We conducted a case-cohort study of incident ESRD cases (n?=?737) with stored blood and a probability sampled subcohort (n?=?4238) and calculated estimated glomerular filtration rate (eGFR) from serum creatinine. 86% of participants were enrolled from community health centers in medically underserved areas and 14% from the general population in 12 states in the southeastern United States. Incident ESRD after entry into the cohort was ascertained by linkage of the cohort with the US Renal Data System (USRDS).

Results

Median (25th, 75th percentile) eGFR at baseline was 63.3 (36.0, 98.2) ml/min/1.73m² for ESRD cases and 103.2 (86.0, 117.9) for subcohort. Black ESRD cases had higher median (25th, 75th) eGFR [63.3 (35.9, 95.9)] compared to whites [59.1 (39.4, 99.2)]. In multivariable Cox models accounting for sampling weights, baseline eGFR was a strong predictor of ESRD risk, and an interaction with race was detected (P?=?0.029). The higher ESRD risk among blacks relative to whites persisted (hazard ratio: 2.58; 95% confidence interval: 1.65, 4.03) after adjustment for eGFR.

Conclusion

In this predominantly lower SES cohort, the racial disparity in ESRD risk is not explained by differences in baseline kidney function.

SUBMITTER: Bock F

PROVIDER: S-EPMC6686512 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Publications

Racial disparities in end-stage renal disease in a high-risk population: the Southern Community Cohort Study.

Bock Fabian F Stewart Thomas G TG Robinson-Cohen Cassianne C Morse Jennifer J Kabagambe Edmond K EK Cavanaugh Kerri L KL Birdwell Kelly A KA Hung Adriana M AM Abdel-Kader Khaled K Siew Edward D ED Akwo Elvis A EA Blot William J WJ Ikizler T Alp TA Lipworth Loren L

BMC nephrology 20190807 1

<h4>Introduction</h4>The Southern Community Cohort Study is a prospective study of low socioeconomic status (SES) blacks and whites from the southeastern US, where the burden of end-stage renal disease (ESRD) and its risk factors are high. We tested whether the 2.4-fold elevated risk of ESRD we previously observed in blacks compared to whites was explained by differences in baseline kidney function.<h4>Methods</h4>We conducted a case-cohort study of incident ESRD cases (n = 737) with stored bloo ...[more]

PMID: 31390993

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Project description:OBJECTIVE:To examine whether lifestyle factors, including sedentary time and physical activity, could independently contribute to risk of end-stage renal disease (ESRD). STUDY DESIGN:Case-cohort study. SETTING:South-eastern USA. PARTICIPANTS:The Southern Community Cohort Study recruited ~86?000 black and white participants from 2002 to 2009. We assembled a case cohort of 692 incident ESRD cases and a probability sample of 4113 participants. PREDICTORS:Sedentary time was calculated as hours/day from daily sitting activities. Physical activity was calculated as metabolic equivalent (MET)-hours/day from engagement in light, moderate and vigorous activities. OUTCOMES:Incident ESRD. RESULTS:At baseline, among the subcohort, mean (SD) age was 52 (8.6) years, and median (25th, 75th centile) estimated glomerular filtration rate (eGFR) was 102.8 (85.9-117.9) mL/min/1.73?m2. Medians (25th-75th centile) for sedentary time and physical activity were 8.0 (5.5-12.0) hours/day and 17.2 (8.7-31.9) MET-hours/day, respectively. Median follow-up was 9.4 years. We observed significant interactions between eGFR and both physical activity and sedentary behaviour (p<0.001). The partial effect plot of the association between physical activity and log relative hazard of ESRD suggests that ESRD risk decreases as physical activity increases when eGFR is 90?mL/min/1.73?m2. The inverse association is most pronounced at physical activity levels >27 MET-hours/day. High levels of sitting time were associated with increased ESRD risk only among those with reduced kidney function (eGFR ?30?mL/min/1.73?m2); this association was attenuated after excluding the first 2?years of follow-up. CONCLUSIONS:In a population with a high prevalence of chronic kidney disease risk factors such as hypertension and diabetes, physical activity appears to be associated with reduced risk of ESRD among those with preserved kidney function. A positive association between sitting time and ESRD observed among those with advanced kidney disease is likely due to reverse causation.

Project description:BackgroundA series of policy changes in 2011 altered reimbursement arrangements and guidance on use of erythropoiesis-stimulating agents for end-stage renal disease (ESRD) patients with anaemia in the US. While the policy changes were principally directed at care delivered in an outpatient setting, these had the potential to affect inpatient care also. This study used HCUP-NIS data (2008-2016) to examine trends in recorded anaemia among ESRD hospitalizations and analyse disparities in inpatient outcomes among ethnic groups following policy changes.MethodsThe International Classification of Diseases codes were used to identify ESRD admissions, recorded anaemia due to chronic kidney disease (CKD), and to generate an age-adjusted Deyo-Charlson comorbidity index. Linear splines with a knot placed at the time point of policy changes and multivariable logistic regression were used to examine the likelihood of recorded anaemia, adjusted for a range of socio-demographic and clinical covariates. Difference-in-difference analyses investigated the impact of policies on recorded anaemia. Other outcomes included hospital cost, mortality and place of discharge.ResultsThe percentage of inpatient episodes with recorded anaemia arising from CKD increased from 26.2% in 2008 to 50.0% in 2016. Anaemia was more likely to be recorded as a complication of ESRD among minority ethnic groups and Native American admissions, in particular, (OR 1.20, 95%CI 1.15-1.25) relative to White American admissions; and these disparities widened following changes to reimbursement. Minorities were less likely to die in hospital and to be discharged to another healthcare facility, and (with the exception of Black American admissions) they were more expensive to treat.ConclusionsOur findings provide evidence of an increase in recorded anaemia consistent with a shift of patients from outpatient to inpatient settings in the wake of changes to reimbursement enacted in 2011. In addition, the study highlights the existence of ethnic disparities that widened after the policy initiated reimbursement changes.

Project description:IntroductionHealth disparities exist at every step of the HIV care continuum (HCC) among racial/ethnic minority population. Such racial/ethnic disparities may have significantly delayed the progress in HCC in the Southern US states that are strongly represented among geographic focus areas in the 2019 federal initiative titled 'Ending the HIV Epidemic: A Plan for America'. However, limited efforts have been made to quantify the long-term spatiotemporal variations of HCC disparities and their contributing factors over time, particularly in the context of COVID-19 pandemic. This project aims to identify the spatiotemporal patterns of racial disparities of each HCC outcome and then determine the contribution of contextual features for temporal change of disparities in HCC.Methods and analysisThis cohort study will use statewide HIV cohort data in South Carolina, including all people living with HIV (PLWH) who were diagnosed with HIV in 2005-2020. The healthcare encounter data will be extracted from longitudinal EHR from six state agencies and then linked to aggregated county-level community and social structural-level data (eg, structural racism, COVID-19 pandemic) from multiple publicly available data sources. The South Carolina Revenue of Fiscal and Affairs will serve as the honest broker to link the patient-level and county-level information. We will first quantify the HCC-related disparities by creating a county-level racial/ethnic disparity index (RDI) for each key HCC outcomes (eg, HIV testing, timely diagnosis), examine the temporal patterns of each RDI over time and then using geographical weighted lasso model examine which contextual factors have significant impacts on the change of county-level RDI from 2005 to 2020.Ethics and disseminationThe study was approved by the Institutional Review Board at the University of South Carolina (Pro00121718) as a Non-Human Subject study. The study's findings will be published in peer-reviewed journals and disseminated at national and international conferences and through social media.

Project description:BACKGROUND:Renal replacement therapy was a lifesaving yet high-cost treatment for people with end-stage kidney disease (ESKD). This study aimed to estimate the direct medical costs per capita of ESKD by different treatment strategies: haemodialysis (HD); peritoneal dialysis (PD); kidney transplantation (KT) (in the first year); KT (in the second year), and by two urban health insurance schemes. METHODS:This was a retrospective observational cohort study. Data were obtained from outpatient and inpatient claims database of two urban health insurance from Guangzhou City, Southern China. Adult patients with HD (n?=?3765; mean age 58?years), PD (n?=?1237; 51?years), KT (first year) (n?=?117; 37?years) and KT (second?year) (n?=?41; 39?years) were identified between 2010 and 2012. The primary outcome was the annual per patient medical costs in 2013 Chinese Yuan (CNY) incurred in the outpatient and inpatient sectors. Secondary outcomes were annual outpatient visits and inpatient admissions, length of stay per admission. Generalized linear regression and bootstrapping statistical methods were used for analysis. RESULTS:The estimated average annual medical costs for patients on HD were CNY 94,760.5 (US$15,066.0), 95% Confidence Interval (CI): CNY85,166.6-106,972.2, which was higher than those for patients on PD [CNY80,762.9 (US$12,840.5), 95% CI: CNY 76,249.8-85,498.9]. The estimated annual cost ratio of HD versus PD was 1.17 (95% CI: 1.12-1.25). Among the transplanted patients, the estimated average annual medical costs in the first year were CNY132,253.0 (US$21,026.9), 95%CI: CNY114,009.9-153,858.6, and in the second year were CNY93,155.3 (US$14,810.8), 95%CI: CNY61,120.6-101,989.1. The mean annual medical costs for dialysis patients under Urban Employee-based Basic Medical Insurance scheme were significantly higher than those for patients under Urban Resident-based Basic Medical Insurance scheme (P?<?0.001). CONCLUSIONS:The direct medical costs of ESKD patients were high and different by types of renal replacement therapy and insurance. The findings can be used to conduct cost-effectiveness research on different types of RRT for ESKD patients that provides economic evidence for health policy design in China.

Dataset Information

Racial disparities in end-stage renal disease in a high-risk population: the Southern Community Cohort Study.

Introduction

Methods

Results

Conclusion

Publications

Racial disparities in end-stage renal disease in a high-risk population: the Southern Community Cohort Study.

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