Abstract: SA-PO843
The Relationship Between County-Level Contextual Determinants and Risk of CKD
Session Information
- CKD: Socioeconomic Context and Mobile Apps
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Xie, Yan, VA Saint Louis Health Care System, Saint Louis, Missouri, United States
- Bowe, Benjamin Charles, VA Saint Louis Health Care System, Saint Louis, Missouri, United States
- Yan, Yan, Washington University School of Medicine, Saint Louis, Missouri, United States
- Xian, Hong, Saint Louis University College for Public Health & Social Justice, St. Louis, Missouri, United States
- Al-Aly, Ziyad, VA Saint Louis Health Care System, Saint Louis, Missouri, United States
Background
Multiple studies described geographic variation in the burden of chronic kidney disease (CKD) in the United States, and evidence suggests that this variation cannot be fully explained by individual level risk factors. We aimed to examine the relationship between county level contextual determinants and individual risk of incident eGFR<60 ml/min/1.73 m2.
Methods
We built a cohort of 2,456,853 US veterans with eGFR>60 ml/min/1.73 m2 and followed for up to five years. Contextual determinants were curated from County Health Ranking databases. High dimensional propensity score method was used to estimate prognostic score for CKD based on individual level risk factors. Logistic regression analyses were conducted to examine the association between contextual determinants and incident eGFR<60 ml/min/1.73 m2, controlling for individual risk factors.
Results
Within 38 contextual determinants, the top 5 determinants which have strongest univariate association with incident eGFR<60 ml/min/1.73 m2 included physical inactivity, injury deaths, some college or above degree, health care costs and median household income. After controlling for sumarized pronostic score, physical inactivity, injury deaths, health care cost and median household income associated with eGFR<60 ml/min/1.73 m2 independent of individual risk factors (table).
Interaction analyses suggested that association between individual risk factors and incident eGFR<60 ml/min/1.73 m2 was modified by county level contextual determinants including physical inactivity, health care costs and median household income.
Conclusion
Contextual determinants are associated risk of eGFR<60 ml/min/1.73 m2 independent of individual risk factor. In addition, they could modify the relationship between individual risk factors and eGFR<60 ml/min/1.73 m2. Contextual determinants may play important role in burden of CKD; their role should be reflected in the national discussion about reducing CKD burden.
Association between contextual determinats and incident eGFR<60 ml/min/1.73 m2
| Contextual determinants | Unit | Univariate OR | OR controlling for individual risk factor | Interaction between contextual determinants and individual risk factors |
| Physical inactivity | 5% | 1.08 (1.08, 1.08) | 1.05 (1.04, 1.05) | P<0.001 |
| Injury deaths | Per 100 in 100,000 | 1.31 (1.29, 1.33) | 1.16 (1.14, 1.17) | P=0.16 |
| Some college or above | 5% | 0.97 (0.97, 0.97) | 0.99 (0.99, 0.99) | P=0.65 |
| Health care costs | Per $10000 | 1.50 (1.47, 1.53) | 1.36 (1.33, 1.40) | P<0.001 |
| Median household income | Per $10000 | 0.96 (0.96, 0.96) | 0.96 (0.96, 0.96) | P<0.001 |
Funding
- Veterans Affairs Support