Low income, community poverty and risk of end stage renal disease

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. Ausführliche Beschreibung

Gespeichert in:

Autor*in:	Crews, Deidra C [verfasserIn] Gutiérrez, Orlando M Fedewa, Stacey A Luthi, Jean-Christophe Shoham, David Judd, Suzanne E Powe, Neil R McClellan, William M

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2014

Schlagwörter:	ESRD Chronic kidney disease Socioeconomic status Disparity Geospatial

Anmerkung:	© Crews et al.; licensee BioMed Central Ltd. 2014

Übergeordnetes Werk:	Enthalten in: BMC nephrology - London : BioMed Central, 2000, 15(2014), 1 vom: 04. Dez.
Übergeordnetes Werk:	volume:15 ; year:2014 ; number:1 ; day:04 ; month:12

Links:	Volltext

DOI / URN:	10.1186/1471-2369-15-192

Katalog-ID:	SPR027513203

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520			\|a 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 > $75,000 group]. There were no statistically significant associations of county measures of poverty with incident ESRD, and no evidence of effect modification. Conclusions In contrast to annual family income, geospatially-linked measures of county poverty have little relation with risk of ESRD. Efforts to mitigate socioeconomic disparities in kidney disease may be best appropriated at the individual level.
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allfields	10.1186/1471-2369-15-192 doi (DE-627)SPR027513203 (SPR)1471-2369-15-192-e DE-627 ger DE-627 rakwb eng Crews, Deidra C verfasserin aut Low income, community poverty and risk of end stage renal disease 2014 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Crews et al.; licensee BioMed Central Ltd. 2014 Background The risk of end stage renal disease (ESRD) is increased among individuals with low income and in low income communities. However, few studies have examined the relation of both individual and community socioeconomic status (SES) with incident ESRD. Methods Among 23,314 U.S. adults in the population-based Reasons for Geographic and Racial Differences in Stroke study, we assessed participant differences across geospatially-linked categories of county poverty [outlier poverty, extremely high poverty, very high poverty, high poverty, neither (reference), high affluence and outlier affluence]. Multivariable Cox proportional hazards models were used to examine associations of annual household income and geospatially-linked county poverty measures with incident ESRD, while accounting for death as a competing event using the Fine and Gray method. Results There were 158 ESRD cases during follow-up. Incident ESRD rates were 178.8 per 100,000 person-years ($ 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. ESRD (dpeaa)DE-He213 Chronic kidney disease (dpeaa)DE-He213 Socioeconomic status (dpeaa)DE-He213 Disparity (dpeaa)DE-He213 Geospatial (dpeaa)DE-He213 Gutiérrez, Orlando M aut Fedewa, Stacey A aut Luthi, Jean-Christophe aut Shoham, David aut Judd, Suzanne E aut Powe, Neil R aut McClellan, William M aut Enthalten in BMC nephrology London : BioMed Central, 2000 15(2014), 1 vom: 04. Dez. (DE-627)326643672 (DE-600)2041348-8 1471-2369 nnns volume:15 year:2014 number:1 day:04 month:12 https://dx.doi.org/10.1186/1471-2369-15-192 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 15 2014 1 04 12
spelling	10.1186/1471-2369-15-192 doi (DE-627)SPR027513203 (SPR)1471-2369-15-192-e DE-627 ger DE-627 rakwb eng Crews, Deidra C verfasserin aut Low income, community poverty and risk of end stage renal disease 2014 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Crews et al.; licensee BioMed Central Ltd. 2014 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. ESRD (dpeaa)DE-He213 Chronic kidney disease (dpeaa)DE-He213 Socioeconomic status (dpeaa)DE-He213 Disparity (dpeaa)DE-He213 Geospatial (dpeaa)DE-He213 Gutiérrez, Orlando M aut Fedewa, Stacey A aut Luthi, Jean-Christophe aut Shoham, David aut Judd, Suzanne E aut Powe, Neil R aut McClellan, William M aut Enthalten in BMC nephrology London : BioMed Central, 2000 15(2014), 1 vom: 04. Dez. (DE-627)326643672 (DE-600)2041348-8 1471-2369 nnns volume:15 year:2014 number:1 day:04 month:12 https://dx.doi.org/10.1186/1471-2369-15-192 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 15 2014 1 04 12
allfields_unstemmed	10.1186/1471-2369-15-192 doi (DE-627)SPR027513203 (SPR)1471-2369-15-192-e DE-627 ger DE-627 rakwb eng Crews, Deidra C verfasserin aut Low income, community poverty and risk of end stage renal disease 2014 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Crews et al.; licensee BioMed Central Ltd. 2014 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. ESRD (dpeaa)DE-He213 Chronic kidney disease (dpeaa)DE-He213 Socioeconomic status (dpeaa)DE-He213 Disparity (dpeaa)DE-He213 Geospatial (dpeaa)DE-He213 Gutiérrez, Orlando M aut Fedewa, Stacey A aut Luthi, Jean-Christophe aut Shoham, David aut Judd, Suzanne E aut Powe, Neil R aut McClellan, William M aut Enthalten in BMC nephrology London : BioMed Central, 2000 15(2014), 1 vom: 04. Dez. (DE-627)326643672 (DE-600)2041348-8 1471-2369 nnns volume:15 year:2014 number:1 day:04 month:12 https://dx.doi.org/10.1186/1471-2369-15-192 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 15 2014 1 04 12
allfieldsGer	10.1186/1471-2369-15-192 doi (DE-627)SPR027513203 (SPR)1471-2369-15-192-e DE-627 ger DE-627 rakwb eng Crews, Deidra C verfasserin aut Low income, community poverty and risk of end stage renal disease 2014 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Crews et al.; licensee BioMed Central Ltd. 2014 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. ESRD (dpeaa)DE-He213 Chronic kidney disease (dpeaa)DE-He213 Socioeconomic status (dpeaa)DE-He213 Disparity (dpeaa)DE-He213 Geospatial (dpeaa)DE-He213 Gutiérrez, Orlando M aut Fedewa, Stacey A aut Luthi, Jean-Christophe aut Shoham, David aut Judd, Suzanne E aut Powe, Neil R aut McClellan, William M aut Enthalten in BMC nephrology London : BioMed Central, 2000 15(2014), 1 vom: 04. Dez. (DE-627)326643672 (DE-600)2041348-8 1471-2369 nnns volume:15 year:2014 number:1 day:04 month:12 https://dx.doi.org/10.1186/1471-2369-15-192 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 15 2014 1 04 12
allfieldsSound	10.1186/1471-2369-15-192 doi (DE-627)SPR027513203 (SPR)1471-2369-15-192-e DE-627 ger DE-627 rakwb eng Crews, Deidra C verfasserin aut Low income, community poverty and risk of end stage renal disease 2014 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © Crews et al.; licensee BioMed Central Ltd. 2014 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. ESRD (dpeaa)DE-He213 Chronic kidney disease (dpeaa)DE-He213 Socioeconomic status (dpeaa)DE-He213 Disparity (dpeaa)DE-He213 Geospatial (dpeaa)DE-He213 Gutiérrez, Orlando M aut Fedewa, Stacey A aut Luthi, Jean-Christophe aut Shoham, David aut Judd, Suzanne E aut Powe, Neil R aut McClellan, William M aut Enthalten in BMC nephrology London : BioMed Central, 2000 15(2014), 1 vom: 04. Dez. (DE-627)326643672 (DE-600)2041348-8 1471-2369 nnns volume:15 year:2014 number:1 day:04 month:12 https://dx.doi.org/10.1186/1471-2369-15-192 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 15 2014 1 04 12
language	English
source	Enthalten in BMC nephrology 15(2014), 1 vom: 04. Dez. volume:15 year:2014 number:1 day:04 month:12
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title	Low income, community poverty and risk of end stage renal disease
ctrlnum	(DE-627)SPR027513203 (SPR)1471-2369-15-192-e
title_full	Low income, community poverty and risk of end stage renal disease
author_sort	Crews, Deidra C
journal	BMC nephrology
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author_browse	Crews, Deidra C Gutiérrez, Orlando M Fedewa, Stacey A Luthi, Jean-Christophe Shoham, David Judd, Suzanne E Powe, Neil R McClellan, William M
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author-letter	Crews, Deidra C
doi_str_mv	10.1186/1471-2369-15-192
title_sort	low income, community poverty and risk of end stage renal disease
title_auth	Low income, community poverty and risk of end stage renal disease
abstract	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 > $75,000 group]. There were no statistically significant associations of county measures of poverty with incident ESRD, and no evidence of effect modification. Conclusions In contrast to annual family income, geospatially-linked measures of county poverty have little relation with risk of ESRD. Efforts to mitigate socioeconomic disparities in kidney disease may be best appropriated at the individual level. © Crews et al.; licensee BioMed Central Ltd. 2014
abstractGer	Background The risk of end stage renal disease (ESRD) is increased among individuals with low income and in low income communities. However, few studies have examined the relation of both individual and community socioeconomic status (SES) with incident ESRD. Methods Among 23,314 U.S. adults in the population-based Reasons for Geographic and Racial Differences in Stroke study, we assessed participant differences across geospatially-linked categories of county poverty [outlier poverty, extremely high poverty, very high poverty, high poverty, neither (reference), high affluence and outlier affluence]. Multivariable Cox proportional hazards models were used to examine associations of annual household income and geospatially-linked county poverty measures with incident ESRD, while accounting for death as a competing event using the Fine and Gray method. Results There were 158 ESRD cases during follow-up. Incident ESRD rates were 178.8 per 100,000 person-years ($ 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 > $75,000 group]. There were no statistically significant associations of county measures of poverty with incident ESRD, and no evidence of effect modification. Conclusions In contrast to annual family income, geospatially-linked measures of county poverty have little relation with risk of ESRD. Efforts to mitigate socioeconomic disparities in kidney disease may be best appropriated at the individual level. © Crews et al.; licensee BioMed Central Ltd. 2014
abstract_unstemmed	Background The risk of end stage renal disease (ESRD) is increased among individuals with low income and in low income communities. However, few studies have examined the relation of both individual and community socioeconomic status (SES) with incident ESRD. Methods Among 23,314 U.S. adults in the population-based Reasons for Geographic and Racial Differences in Stroke study, we assessed participant differences across geospatially-linked categories of county poverty [outlier poverty, extremely high poverty, very high poverty, high poverty, neither (reference), high affluence and outlier affluence]. Multivariable Cox proportional hazards models were used to examine associations of annual household income and geospatially-linked county poverty measures with incident ESRD, while accounting for death as a competing event using the Fine and Gray method. Results There were 158 ESRD cases during follow-up. Incident ESRD rates were 178.8 per 100,000 person-years ($ 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. © Crews et al.; licensee BioMed Central Ltd. 2014
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title_short	Low income, community poverty and risk of end stage renal disease
url	https://dx.doi.org/10.1186/1471-2369-15-192
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author2	Gutiérrez, Orlando M Fedewa, Stacey A Luthi, Jean-Christophe Shoham, David Judd, Suzanne E Powe, Neil R McClellan, William M
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