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Geographic Variation and US County Characteristics Associated With Rapid Kidney Function Decline.
Benjamin Bowe1, Yan Xie1, Hong Xian1,2
1Clinical Epidemiology Center, Research and Education Service, VA Saint Louis Health Care System, Saint Louis, Missouri, USA.
Kidney International Reports
|November 17, 2017
Summary
Geographic variations in rapid kidney function decline were observed among US veterans. County characteristics related to health, socioeconomic, and environmental factors were associated with this decline.
Area of Science:
- Nephrology
- Epidemiology
- Public Health
Background:
- Previous studies reported geographic variations in chronic kidney disease prevalence and end-stage renal disease incidence.
- The geographic epidemiology of rapid estimated glomerular filtration rate (eGFR) decline remains under-examined.
Purpose of the Study:
- To characterize the spatial epidemiology of rapid eGFR decline in a large cohort of US veterans.
- To examine associations between US county characteristics and rapid eGFR decline.
Main Methods:
- A longitudinal cohort of 2,107,570 US veterans was established.
- Spatial epidemiology and county-level associations with rapid eGFR decline were analyzed.
Main Results:
- 8.02% of the cohort experienced rapid eGFR decline (slope < -5 ml/min/1.73 m²/year).
- Prevalence of rapid eGFR decline varied significantly by county, persisting across strata of diabetes and hypertension.
- County characteristics including health outcomes, behaviors, clinical care, socioeconomic conditions, physical environment, and diversity were associated with increased odds of rapid eGFR decline.
Conclusions:
- Substantial geographic variation in rapid eGFR decline exists among US veterans.
- County-level factors encompassing health, socioeconomic, environmental, and diversity conditions are associated with rapid eGFR decline.
- These findings highlight the need for geographically targeted interventions to mitigate kidney function decline.
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