Spatial distribution of inequalities in end-stage renal disease in the United States

This paper assesses the locally varying effects of socioeconomic, racial and morbidity-related geographic heterogeneity on end-stage renal disease prevalence in the contiguous United States. Employing an exploratory spatial data analysis and a geographically weighted Poisson regression that takes into account spatial nonstationarity, spatial autocorrelation and the nature of count data, findings indicate a striking continental divide in the United States not only in terms of ESRD burden but also in terms of all of its risk factors whose effects significantly vary over space. A deepening of socioeconomic heterogeneity has the strongest ESRD prevalence-increasing-effects in counties of the southeastern states. On the other hand, rising prevalence of comorbid conditions and behavioral risk factors such as obesity, diabetes and binge drinking prevalence has the strongest ESRD prevalence-increasing-effects in counties of the Pacific states.