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Abstract: PO2320

Social Determinants of Health (SDOH), Environmental Inequities and ESRD Among US Veterans: An Integration of Ecological and Spatial Approaches

Session Information

Category: CKD (Non-Dialysis)

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

Authors

  • Han, Yun, University of Michigan, Ann Arbor, Michigan, United States
  • Bragg-Gresham, Jennifer L., University of Michigan, Ann Arbor, Michigan, United States
  • Steffick, Diane, University of Michigan, Ann Arbor, Michigan, United States
  • Zhang, Xiaosong, University of Michigan, Ann Arbor, Michigan, United States
  • Gillespie, Brenda W., University of Michigan, 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
  • Wyncott, April, University of Michigan, Ann Arbor, Michigan, United States
  • Weitzel, William, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
  • Singh, Karandeep, University of Michigan, Ann Arbor, Michigan, United States
  • Crowley, Susan T., VA Connecticut Healthcare System - West Haven Campus, West Haven, Connecticut, United States
  • Saran, Rajiv, University of Michigan, Ann Arbor, Michigan, United States
Background

Disparities in kidney health are often due to underlying environmental and social determinants of health (SDOH). We assessed geographic variation and the association between air pollution, SDOH, and ESRD in US veterans at county-level.

Methods

We used data from about 3 million Veterans with CKD between the years of 2006-2016 (prevalent and incident CKD cases). Environmental and SDOH were obtained from various data sets, including the American Community Survey (2009), the National Neighborhood Data Archive (2006) and others. County prevalence of ESRD was calculated as # ESRD cases/1000 person-years. County-level environmental factors and SDOH included average daily PM2.5, neighborhood disadvantage index, etc. A geographically weighted regression model (GWR) was applied to explore the relationship between SDOH, air pollution and prevalence of ESRD.

Results

Average of county-level prevalence of ESRD was 3.1/1000 person-years (SD=0.21, n=3,231). The prevalence of ESRD was higher in the rust-belt area of the Midwest and the Southeast region (Fig1a). Neighborhood disadvantage index was associated with higher ESRD prevalence in the West and parts of the Midwest (Fig1b). PM2.5 was associated with higher prevalence in the East North Central and South West Central regions (Fig1c).

Conclusion

Variation exists in the association between environmental factors, SDOH and the presence of ESRD geographically. It highlights the importance of attention to the environment and community-based SDOH, toward preventing and managing ESRD based on residence and individualized patient care.

Funding

  • Veterans Affairs Support