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Abstract: PO2264

Racial Disparities in Progression to ESRD and Mortality in Rural vs. Urban Veterans

Session Information

Category: CKD (Non-Dialysis)

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

Authors

  • Sammons, Stephen R., The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Wei, Guo, The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Boucher, Robert E., The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Carle, Judy, The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Gonce, Victoria, The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Hartsell, Sydney Elizabeth, The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Abraham, Nikita, The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Beddhu, Srinivasan, The University of Utah School of Medicine, Salt Lake City, Utah, United States
Background

Little is known about how race and rurality interact to influence progression of CKD to ESRD and mortality in CKD patients.

Methods

We analyzed a national cohort (n=915,039) of veterans with CKD (eGFR < 60 on two or more outpatient serum creatinines >60 days apart) who received care from 1/1/2010-12/31/2015 and who had information on demographics, comorbidities, and residence coding available. ESRD data was obtained by linkage to USRDS.

Cox linear regression models were used to relate rural and urban residence defined by RUCA codes with time to incidence of ESRD, as well as time to all-cause mortality. The models were adjusted for age, gender, and comorbidities. The full cohort was examined as well as two subgroups divided by race. Hazard ratios were calculated using the urban (RUCA 1.0 & 1.1) veterans within the full cohort or each subgroup as a reference.

Results

When compared to urban veterans, veterans who reside in rural regions had lower risk of ESRD (HR 0.89 , 95% CI 0.87-0.91) but had a slightly higher risk of mortality (HR 1.03, 95% CI 1.02-1.03). Within race subgroups, White rural veterans had lower risk of ESRD compared to White urban veterans (HR 0.88, 95% CI 0.85-0.91) but not in Black rural versus Black urban veterans (HR 0.99, 95% CI 0.93-1.05). While rural White veterans had slightly higher risk of mortality compared to urban White veterans (HR 1.02 , 95% 1.01-1.02), the difference in mortality between rural and urban veterans was much larger in the Black subgroup (HR 1.11 , 95% CI 1.08-1.14).

Conclusion

Examination of CKD patients cared for by the VA reveals an intersection between race and rurality in which mortality is increased for Black rural veterans with CKD. Interventions to improve preESRD care in rural Black veterans are needed.

Funding

  • NIDDK Support