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Low use of routine medical care among African Americans with high CKD risk: the Jackson Heart Study
Clarissa J Diamantidis1,2, Clemontina A Davenport3, Joseph Lunyera4
1Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA. clarissa.diamantidis@duke.edu.
Insights
African Americans with chronic kidney disease (CKD) risk factors use routine medical care (RMC) less often. Younger age, male sex, lower education, and low provider trust are linked to reduced RMC use, highlighting disparities.
Area of Science:
- Nephrology
- Public Health
- Health Disparities
Background:
- Routine medical care (RMC) is crucial for managing chronic kidney disease (CKD) risks.
- African Americans experience significant ethnic/racial disparities in CKD, with lower RMC utilization.
- Factors contributing to low RMC use among African Americans at risk for renal outcomes require investigation.
Purpose of the Study:
- To investigate sociodemographic, comorbidity, healthcare access, and psychosocial factors associated with low RMC use in African Americans at risk for CKD.
- To identify specific characteristics of African Americans with CKD, diabetes, or hypertension who are less likely to engage in RMC.
Main Methods:
- A cross-sectional study analyzed data from 3191 African American participants with CKD, diabetes, or hypertension.
- Low RMC use was defined as no physical exam within one year.
- Multivariable logistic regression assessed associations between various factors and low RMC use.
Main Results:
- 21.9% of participants reported low RMC use.
- Younger age (<55 years), male sex, lower educational attainment (
- Psychosocial factors including low trust in providers, high stress, and experiences of discrimination were also linked to reduced RMC use.
Conclusions:
- High-risk African Americans who are younger, male, less educated, and have low provider trust are more likely to have low RMC use.
- Targeted interventions focusing on these subgroups can help reduce RMC disparities.
- Improving RMC utilization is essential to mitigate CKD disparities among African Americans.
Background:
Use of routine medical care (RMC) is advocated to address ethnic/racial disparities in chronic kidney disease (CKD) risks, but use is less frequent among African Americans. Factors associated with low RMC use among African Americans at risk of renal outcomes have not been well studied.
Methods:
We examined sociodemographic, comorbidity, healthcare access, and psychosocial (discrimination, anger, stress, trust) factors associated with low RMC use in a cross-sectional study. Low RMC use was defined as lack of a physical exam within one year among participants with CKD (estimated glomerular filtration rate < 60 mL/min/1.73m2 or urine albumin-to-creatinine ratio > 30 mg/g) or CKD risk factors (diabetes or hypertension). We used multivariable logistic regression to estimate the odds of low RMC use at baseline (2000-2004) for several risk factors.
Results:
Among 3191 participants with CKD, diabetes, or hypertension, 2024 (63.4%) were ≥ 55 years of age, and 700 (21.9%) reported low RMC use. After multivariable adjustment, age < 55 years (OR 1.61 95% CI 1.31-1.98), male sex (OR 1.71; 1.41-2.07),
Conclusions:
High-risk African Americans who were younger, male, less-educated, and with low trust in providers were more likely to report low RMC use. Efforts to improve RMC use by targeting these populations could mitigate African Americans' disparities in CKD risks.
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