Neighborhood context and kidney disease in Philadelphia
Neighborhood context and kidney disease in Philadelphia
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DOI：
10.1016/j.ssmph.2020.100646
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发表时间：
2020-12-01
影响因子：
4.7
通讯作者：
Harhay, Meera N.
中科院分区：
文献类型：
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作者：
Boyle, Suzanne M.;Zhao, Yuzhe;Harhay, Meera N.
社区环境可能会影响慢性肾脏疾病(CKD)的风险，这种疾病影响大约10%的美国人口，并与显著的发病率、死亡率和成本相关。我们包括宾夕法尼亚州费城23,692名患者的样本，他们在2016年1月1日至2017年12月31日期间在一家大型学术初级保健诊所就诊。我们使用广义线性方程来估计社区环境指标(例如，接近健康食品店、社区步行能力、社会资本、犯罪率、社会经济地位)与CKD之间的关联，并根据年龄、性别、种族/民族和保险覆盖范围进行调整。在CKD患者中，次要结果是血糖控制不佳(血红蛋白A1c；=6.5%)和血压失控(收缩压和/或舒张压=140 mm Hg和/或舒张压=90 mm Hg)。这一队列代表了费城97%人口普查区域的居民。CKD患病率为10%。当所有社区背景指标被综合考虑时，只有较低的社区社会经济指数(对社区收入、教育程度和职业的综合评估)与CKD的风险较高(最低三分位数与最高三分位数：调整后的相对风险[ARR]1.46[1.25，1.69]；中三分位数与最高三分位数：ARR 1.35[1.25，1.52])。在CKD患者中，与居住在最适宜步行的社区(即大多数基本资源可以步行到达的社区)相比，居住在中等水平WalkScore(R)的社区(即只有一些必要的社区资源可以步行到达的社区)与血糖控制较差独立相关(ARR1.20，95%可信区间1.01-1.42)。这些发现表明，社区社会经济地位的测量在确定将从CKD筛查和治疗中受益的社区方面具有潜在的作用。还需要研究来确定机制，以解释为什么居住在不容易步行或开车导航的社区可能会阻碍CKD患者的血糖控制。
Neighborhood context might influence the risk of chronic kidney disease (CKD), a condition that impacts approximately 10% of the United States population and is associated with significant morbidity, mortality, and costs. We included a sample of 23,692 individuals in Philadelphia, Pennsylvania, who were seen in a large academic primary care practice between January 1, 2016 and December 31, 2017. We used generalized linear equations to estimate the associations between indicators of neighborhood context (e.g., proximity to healthy foods stores, neighborhood walkability, social capital, crime rate, socioeconomic status) and CKD, adjusted for age, sex, race/ethnicity, and insurance coverage. Among those with CKD, secondary outcomes were poor glycemic control (hemoglobin A1c >= 6.5%) and uncontrolled blood pressure (systolic >= 140 mm Hg and/or diastolic >= 90 mm Hg). The cohort represented residents from 97% of Philadelphia census tracts. CKD prevalence was 10%. When all neighborhood context metrics were considered collectively, only lower neighborhood socioeconomic index (a composite assessment of neighborhood income, educational attainment, and occupation) was associated with a higher risk of CKD (lowest tertile vs. highest tertile: adjusted relative risk [aRR] 1.46 [1.25, 1.69]; mid-tertile vs. highest-tertile: aRR 1.35 [1.25, 1.52]). Among those with CKD, compared to residence in the most walkable neighborhoods (i.e., where most essential resources are accessible by foot), residence in neighborhoods with mid-level WalkScore (R) (i.e., where only some essential neighborhood resources are accessible by foot) was independently associated with poor glycemic control (aRR 1.20, 95% CI 1.01-1.42). These findings suggest a potential role for measures of neighborhood socioeconomic status in identifying communities that would benefit from screening and treatment for CKD. Studies are also needed to determine mechanisms to explain why residence in neighborhoods not easily navigated by foot or car might hinder glycemic control among people with CKD.