Neighborhood poverty and racial differences ion ESRD incidence
Neighborhood poverty and racial differences ion ESRD incidence
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DOI：
10.1681/asn.2006080934
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发表时间：
2008-02-01
影响因子：
13.6
通讯作者：
Presleyt, Rodney
中科院分区：
文献类型：
--
作者：
Volkova, Nataliya;McClellan, William;Presleyt, Rodney
贫困与终末期肾病风险增加有关，但其对观察到的疾病发病率种族差异的贡献尚未明确。为了探讨社区贫困对ESRD发病率种族差异的影响，我们分析了美国人口普查和ESRD网络6数据的组合，包括1998年1月至2002年12月期间在格鲁吉亚、北卡罗来纳州或南卡罗来纳州开始透析的34，767例患者。人口普查区被用作分析的地理单位，生活在贫困线以下的人口普查区人口比例是我们衡量邻里贫困的指标。ESRD发病率采用两级Poisson回归建模，其中种族、年龄和性别为个体协变量（1级），人口普查区贫困为社区协变量（2级）。无论是黑人还是白人，社区贫困都与ESRD的高发病率密切相关。贫困的增加与黑人和白人之间ESRD率的更大差异有关，前者的风险更大。这增加了黑人可能比白人遭受更低的社会经济条件的可能性。在所有贫穷程度上，这种差距依然存在。随着社区贫困的增加，美国黑人ESRD发病率越来越高的原因仍有待解释。
Poverty is associated with increased risk of ESRD, but its contribution to observed racial differences in disease incidence is not well-defined. To explore the contribution of neighborhood poverty to racial disparity in ESRD incidence, we analyzed a combination of US Census and ESRD Network 6 data comprising 34,767 patients that initiated dialysis in Georgia, North Carolina, or South Carolina between January 1998 and December 2002. Census tracts were used as the geographic units of analysis, and the proportion of the census tract population living below the poverty level was our measure of neighborhood poverty. Incident ESRD rates were modeled using two-level Poisson regression, where race, age and gender were individual covariates (level 1), and census tract poverty was a neighborhood covariate (level 2). Neighborhood poverty was strongly associated with higher ESRD incidence for both blacks and whites. Increasing poverty was associated with a greater disparity in ESRD rates between blacks and whites, with the former at greater risk. This raises the possibility that blacks may suffer more from lower socioeconomic conditions than whites. The disparity persisted across all poverty levels. The reasons for increasingly higher ESRD incidence among US blacks as neighborhood poverty increases remain to be explained.