Kidney Week

Abstract: FR-OR16

Incidence of CKD and Environmental Inequities: An Integration of Ecological and Spatial Approaches in US Veterans

Session Information

• Clinical Trials and Related Studies to Improve CKD Outcomes
  October 23, 2020 | Location: Simulive
  Abstract Time: 05:00 PM - 07:00 PM

Category: CKD (Non-Dialysis)

• 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Han, Yun, University of Michigan Medical School, Ann Arbor, Michigan, United States

Yun Han



Yun Han, MS, PhD, is Assistant Research Scientist in the Division of Nephrology, Department of Internal Medicine and at Kidney Epidemiology and Cost Center, University of Michigan. She obtained her MS in health policy and management at University of California, Los Angeles and received her PhD degree in social and administrative sciences in pharmacy at University of Michigan. Her research interests centre around health services research and pharmacoepidemiology. As a health services researcher, Yun has over 8 years of experience in using claim data to assess healthcare utilization and treatment outcomes. Yun is skilled in statistical modeling techniques and methodology, and has exceptional understanding and training in epidemiological principles. She had assisted the analytical work for the CDC CKD Surveillance Project and in the United States Renal Data System.She is currently involved research projects related with assessing quality of care in patients with chronic kidney disease and spatial analysis of kidney disease.

• Bragg-Gresham, Jennifer L., University of Michigan Medical School, Ann Arbor, Michigan, United States

Jennifer L. Bragg-Gresham,

• Steffick, Diane, University of Michigan Medical School, Ann Arbor, Michigan, United States

Diane Steffick,

• Zhang, Xiaosong, University of Michigan Medical School, Ann Arbor, Michigan, United States

Xiaosong Zhang,

• Wyncott, April, University of Michigan Medical School, Ann Arbor, Michigan, United States

April Wyncott,

• Veinot, Tiffany C., University of Michigan, Ann Arbor, Michigan, United States

Tiffany C. Veinot,

• Vydiswaran, V. G. Vinod, University of Michigan, Ann Arbor, Michigan, United States

V. G. Vinod Vydiswaran,

• Gillespie, Brenda W., University of Michigan, Ann Arbor, Michigan, United States

Brenda W. Gillespie,

• Weitzel, William, Veterans Health Administration, Ann Arbor, Michigan, United States

William Weitzel,

• Singh, Karandeep, University of Michigan Medical School, Ann Arbor, Michigan, United States

Karandeep Singh,

• Crowley, Susan T., Veterans Health Administration, West Haven, Connecticut, United States

Susan T. Crowley,

• Saran, Rajiv, University of Michigan Medical School, Ann Arbor, Michigan, United States

Rajiv Saran,

Background

Disparities in chronic kidney disease (CKD) can be linked to social and environmental determinants of health, which vary geographically across the US. We assessed geographic variation and the impact of environmental factors on incident CKD in US veterans.

Methods

We used a linked dataset from Veterans Health Administration (2014-18), the American Community Survey(2018); National Environmental Public Health Tracking Network(2018); EPA(2019) and Reference USA(2017). Incident cases of CKD were individuals with eGFR < 60 mL/min/1.73m² and without prior indication of CKD for at least 3 years. The county-level incidence rate of CKD was number of cases/1000 person-years during 2016-18. County-level environmental factors included Townsend deprivation index; neighborhood indices; average daily PM2.5; walkability index; number of recreational facilities and fast-food restaurants. A geographically-weighted regression model(GWR) was applied to investigate the relationship between environmental factors and incidence rate of CKD.

Results

Average of incident rate of CKD was 34.8/1000 person-years (SD=12.3, n=2,718). Incident rate was higher in the rust-belt area and Appalachian region (Fig 1.a). Townsend deprivation index associated with higher incident rate in the Midwest, Northern California and Texas (Fig 1.b). PM2.5 was associated with higher incident rate in the East North Central and East West Central regions (Fig 1.c).

Conclusion

Different environmental factors were associated with incident CKD in US counties. This highlights the potential importance of allocating resources for varied approaches to preventing and slowing the progression of CKD based on residence.

Funding

• Veterans Affairs Support