Race and end-stage renal disease. Socioeconomic status and access to health care as mediating factors
T. V. Perneger, P. K. Whelton and M. J. Klag
Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md, USA.
OBJECTIVE: To examine whether lower socioeconomic status and limited access
to health care explain the racial inequities in the incidence of end-stage
renal disease (ESRD), and whether these factors are independently
associated with ESRD. METHODS: This case-control study compared 716
patients with ESRD with 361 population controls of the same age, 20 to 64
years old, from Maryland, Virginia, West Virginia, and Washington, DC.
Race, indicators of socioeconomic status (household annual income, years of
education), and indicators of access to health care (health insurance
status, number of missing teeth, usual source of care, use of preventive
services) were assessed via a telephone interview. RESULTS: Independent
risk factors for ESRD included non-white race (odds ratio for blacks, 5.5;
95% confidence interval, 3.8 to 8.0; odds ratio for other nonwhites, 3.5;
95% confidence interval, 1.2 to 10.0), categories of income (odds ratio
gradient, 1.0 to 4.5; 95% confidence interval, 2.6 to 7.8), receipt of
Medicaid benefits (odds ratio, 3.5; 95% confidence interval, 1.5 to 8.4),
and number of missing teeth (odds ratio gradient, 1.0 to 2.2; 95%
confidence interval, 1.2 to 4.1). Adjustment for socioeconomic variables
reduced the odds ratio for blacks only partially, from 8.1 to 5.5. The
proportions of ESRD incidence that could be attributed to each risk factor
were 46% for minority race, 53% for income categories, and 33% for missing
teeth. CONCLUSIONS: Low socioeconomic status and limited access to health
care were strong risk factors for kidney failure, but they explained only
part of the excess of ESRD in blacks. Racial and social factors account for
a large part of ESRD incidence. The mechanisms of these associations should
be targeted by further research.
Socioeconomic Disadvantage and Kidney Disease in the United States, Australia, and Thailand
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Ramirez
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Salem et al.
J. Am. Soc. Nephrol. 2008;19:600-614.
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Volkova et al.
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O'Hare et al.
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Ward
Arch Intern Med 2007;167:1083-1091.
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Xue et al.
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McClellan et al.
J. Am. Soc. Nephrol. 2006;17:1710-1715.
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Low Ankle-Brachial Index Associated With Rise in Creatinine Level Over Time: Results From the Atherosclerosis Risk in Communities Study
O'Hare et al.
Arch Intern Med 2005;165:1481-1485.
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McClellan and Flanders
J. Am. Soc. Nephrol. 2003;14:S65-70.
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Socio-economic status and chronic renal failure: a population-based case-control study in Sweden
Fored et al.
Nephrol Dial Transplant 2003;18:82-88.
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Excess Risk of Chronic Kidney Disease among African-American versus White Subjects in the United States: A Population-Based Study of Potential Explanatory Factors
Tarver-Carr et al.
J. Am. Soc. Nephrol. 2002;13:2363-2370.
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National Profile of Practice Patterns for Hemodialysis Vascular Access in the United States
Reddan et al.
J. Am. Soc. Nephrol. 2002;13:2117-2124.
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Commentary: Extending the boundaries of data collection by mail
Perneger and Etter
Int J Epidemiol 2001;30:301-302.
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Auerbach et al.
J Am Coll Cardiol 2000;36:2119-2125.
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Low Birth Weights Contribute to the High Rates of Early-Onset Chronic Renal Failure in the Southeastern United States
Lackland et al.
Arch Intern Med 2000;160:1472-1476.
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Literacy, Cultural Diversity, and Client Education
Davidhizar and Brownson
Home Health Care Management Practice 2000;12:38-44.
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Krop et al.
Arch Intern Med 1999;159:1777-1783.
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