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Abstract: FR-OR16

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

Session Information

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
  • Bragg-Gresham, Jennifer L., University of Michigan Medical School, Ann Arbor, Michigan, United States
  • Steffick, Diane, University of Michigan Medical School, Ann Arbor, Michigan, United States
  • Zhang, Xiaosong, University of Michigan Medical School, Ann Arbor, Michigan, United States
  • Wyncott, April, University of Michigan Medical School, Ann Arbor, Michigan, United States
  • Veinot, Tiffany C., University of Michigan, Ann Arbor, Michigan, United States
  • Vydiswaran, V. G. Vinod, University of Michigan, Ann Arbor, Michigan, United States
  • Gillespie, Brenda W., University of Michigan, Ann Arbor, Michigan, United States
  • Weitzel, William, Veterans Health Administration, Ann Arbor, Michigan, United States
  • Singh, Karandeep, University of Michigan Medical School, Ann Arbor, Michigan, United States
  • Crowley, Susan T., Veterans Health Administration, West Haven, Connecticut, United States
  • Saran, Rajiv, University of Michigan Medical School, Ann Arbor, Michigan, United States
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