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Abstract: PO0474

Social Determinants of CKD in the Military Health System

Session Information

Category: CKD (Non-Dialysis)

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

Authors

  • Norton, Jenna M., Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
  • Grunwald, Lindsay, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
  • Olsen, Cara H., Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
  • Marks, Eric S., Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
  • Koehlmoos, Tracey L., Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
Background

A growing body of evidence suggests that negative social determinants of health—or social risks—contribute to socioeconomic and racial disparities in chronic kidney disease (CKD). One mechanism through which social risks appear to produce disease is by impeding access to healthcare. The Military Health System (MHS) provides an opportunity to assess CKD disparities in the context of universal healthcare.

Methods

We identified all MHS beneficiaries aged 18 to 64 who received care through the MHS from October 1, 2015 to September 30, 2018. CKD was identified by ICD-10 code and/or a validated laboratory value-based electronic phenotype for CKD. Directed acyclic graphs were developed to understand potential confounding or mediating roles of covariates. Multivariable logistic regression models were used to compare the prevalence of CKD by race, rank, zip code level median household income, and marital status, controlling separately for suspected confounders (age, sex, active duty status, service branch, and depression) and mediators (hypertension, diabetes, HIV and BMI). For family beneficiaries, the sponsor’s rank and zip code were used.

Results

Of the 3,330,893 MHS beneficiaries in this analysis, 105,504 (3.2%) were identified as having CKD. In confounder-adjusted models, CKD prevalence was statistically elevated in beneficiaries of black vs white race, lower vs higher rank (as a proxy for socioeconomic status), lower vs higher income, and married vs single status (p <.0001). As expected, associations were partially or fully mitigated when further adjusting for suspected mediators, indicating the mediators may indeed be on the causal pathway between social risks and CKD.

Conclusion

Racial and socioeconomic disparities persist in CKD under the conditions of universal healthcare coverage provided by the MHS. While racial disparities may result in part from underlying genetic differences, the presence of disparities by rank and area income suggest social factors remain pertinent despite access to universal healthcare coverage.

Funding

  • Other U.S. Government Support