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Race differences in access to health care and disparities in incident chronic kidney disease in the US.

Publication ,  Journal Article
Evans, K; Coresh, J; Bash, LD; Gary-Webb, T; Köttgen, A; Carson, K; Boulware, LE
Published in: Nephrol Dial Transplant
March 2011

BACKGROUND: The contribution of race differences in access to health care to disparities in chronic kidney disease (CKD) incidence in the United States is unknown. METHODS: We examined race differences in usual source of health care, health insurance and CKD incidence among 3883 Whites and 1607 Blacks with hypertension or diabetes enrolled in the Atherosclerosis Risk in Communities Study. In multivariable analyses, we explored the incremental contribution of access to health care in explaining Blacks' excess CKD incidence above and beyond other socioeconomic, lifestyle and clinical factors. RESULTS: Compared with Whites, Blacks had poorer access to health care (3 vs 0.3% with no usual source of health care or health insurance, P < 0.001) and experienced greater CKD incidence (14.7 vs 12.0 cases per 1000 person-years, P < 0.001). Blacks' excess risk of CKD persisted after adjusting for demographic, socioeconomic, lifestyle and clinical factors [hazard ratio (HR) (95% confidence interval (95% CI)) = 1.21 (1.01-1.47)]. Adjustment for these factors explained 64% of the excess risk among Blacks. The increased risk for CKD among Blacks was attenuated after additional adjustment for race differences in access to health care [HR (95% CI) = 1.19 (0.99-1.45)], which explained an additional 10% of the disparity. Conclusions. In this population at risk for developing CKD, we found that poorer access to health care among Blacks explained some of Blacks' excess risk of CKD, beyond the excess risk explained by demographic, socioeconomic, lifestyle and clinical factors. Improved access to health care for high-risk individuals could narrow disparities in CKD incidence.

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Published In

Nephrol Dial Transplant

DOI

EISSN

1460-2385

Publication Date

March 2011

Volume

26

Issue

3

Start / End Page

899 / 908

Location

England

Related Subject Headings

  • White People
  • Urology & Nephrology
  • United States
  • Socioeconomic Factors
  • Prospective Studies
  • Middle Aged
  • Male
  • Kidney Failure, Chronic
  • Insurance, Health
  • Incidence
 

Citation

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Chicago
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Evans, K., Coresh, J., Bash, L. D., Gary-Webb, T., Köttgen, A., Carson, K., & Boulware, L. E. (2011). Race differences in access to health care and disparities in incident chronic kidney disease in the US. Nephrol Dial Transplant, 26(3), 899–908. https://doi.org/10.1093/ndt/gfq473
Evans, Kira, Josef Coresh, Lori D. Bash, Tiffany Gary-Webb, Anna Köttgen, Kathryn Carson, and L Ebony Boulware. “Race differences in access to health care and disparities in incident chronic kidney disease in the US.Nephrol Dial Transplant 26, no. 3 (March 2011): 899–908. https://doi.org/10.1093/ndt/gfq473.
Evans K, Coresh J, Bash LD, Gary-Webb T, Köttgen A, Carson K, et al. Race differences in access to health care and disparities in incident chronic kidney disease in the US. Nephrol Dial Transplant. 2011 Mar;26(3):899–908.
Evans, Kira, et al. “Race differences in access to health care and disparities in incident chronic kidney disease in the US.Nephrol Dial Transplant, vol. 26, no. 3, Mar. 2011, pp. 899–908. Pubmed, doi:10.1093/ndt/gfq473.
Evans K, Coresh J, Bash LD, Gary-Webb T, Köttgen A, Carson K, Boulware LE. Race differences in access to health care and disparities in incident chronic kidney disease in the US. Nephrol Dial Transplant. 2011 Mar;26(3):899–908.
Journal cover image

Published In

Nephrol Dial Transplant

DOI

EISSN

1460-2385

Publication Date

March 2011

Volume

26

Issue

3

Start / End Page

899 / 908

Location

England

Related Subject Headings

  • White People
  • Urology & Nephrology
  • United States
  • Socioeconomic Factors
  • Prospective Studies
  • Middle Aged
  • Male
  • Kidney Failure, Chronic
  • Insurance, Health
  • Incidence