Material Need Insecurities among People on Hemodialysis: Burden, Sociodemographic Risk Factors, and Associations with Substance Use.
Material Need Insecurities among People on Hemodialysis: Burden, Sociodemographic Risk Factors, and Associations with Substance Use.
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DOI：
10.34067/kid.0000000000000279
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发表时间：
2023-11-01
期刊：
影响因子：
--
通讯作者：
Crews DC
中科院分区：
文献类型：
--
作者：
Taylor KS;Novick TK;Santos SR;Chen Y;Smith OW;Perrin NA;Crews DC
粮食不安全和住房不稳定可能会通过治疗依从性等健康行为及其对移植或家庭透析治疗的影响来影响透析结果。接受血液透析的人年龄较小、受教育程度较低、收入较低或面临经济压力，更有可能经历物质需求的不安全感。尽管居住隔离缓和了年龄、性别和粮食不安全之间的关联，但参与者的种族与物质需求不安全感无关。尽管与健康结果相关，但关于接受血液透析的成年人的粮食不安全和住房不稳定率的报告仍然有限。对于该人群来说，它们与社会人口统计和行为因素的关系尚不清楚。我们对在巴尔的摩和华盛顿特区大都市区设施接受血液透析的人进行了方便抽样。参与者完成了社会经济地位、粮食不安全、住房不稳定和药物滥用障碍的衡量。我们将参与者和设施的邮政编码与地区贫困和居住隔离的衡量标准进行了交叉引用。我们使用多变量逻辑回归模型研究了个人层面和地区层面的社会人口特征、粮食不安全和住房不稳定之间的关联。在完成研究调查的 305 名参与者中，57% 是男性，70% 是黑人，平均年龄为 60 岁。 36% 的样本表示粮食不安全，18% 表示住房不稳定，31% 表示使用中度或高风险物质。年龄较小、受教育程度较低、收入较低或经济紧张的接受血液透析的人更有可能存在物质需求不安全感（全部 P < 0.05）。在居住在隔离管辖区的参与者中，与女性相比，男性出现粮食不安全的几率更高（比值比 3.7；95% 置信区间，1.61 至 8.53）；与年长参与者相比，年轻参与者（年龄 <55 岁）出现粮食不安全的几率更高（比值比 3.3；95% 置信区间，1.49 至 7.32）。在隔离程度较低的县，性别或较低年龄类别与粮食不安全之间的关联不具有统计学意义（居住隔离×性别的 P 交互作用：P = 0.006；居住隔离×较低年龄类别：P = 0.12）。食品不安全、住房不稳定和药物滥用在接受血液透析的成年人样本中很常见。接受血液透析的年轻人，尤其是居住在隔离居住地区的年轻人，面临的粮食不安全风险更大。未来的研究应该考察物质需求的不安全感是否会导致透析结果的差异长期存在。本文包含一个播客 https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/K360/2023_12_01_KID0000000000000279.mp3
Food insecurity and housing instability may affect dialysis outcomes through health behaviors like treatment adherence and their effect on access to transplantation or home dialysis therapies. People on hemodialysis who were younger, with less educational attainment, with lower incomes, or experiencing financial strain were more likely to experience material need insecurities. Participant race was not associated with material need insecurities, although residential segregation moderated associations between age, sex, and food insecurity. Despite their relevance to health outcomes, reports of food insecurity and housing instability rates among adults on hemodialysis are limited. Their relation to sociodemographic and behavioral factors are unknown for this population. We enrolled a convenience sample of people receiving hemodialysis at Baltimore and Washington, DC metropolitan area facilities. Participants completed measures of socioeconomic position, food insecurity, housing instability, and substance use disorder. We cross-referenced participant and facility zip codes with measures of area poverty and residential segregation. We examined associations between individual-level and area-level sociodemographic characteristics, food insecurity, and housing instability using multivariable logistic regression models. Of the 305 participants who completed study surveys, 57% were men and 70% were Black, and the mean age was 60 years. Thirty-six percent of the sample reported food insecurity, 18% reported housing instability, and 31% reported moderate or high-risk substance use. People on hemodialysis who were younger, with lower educational attainment, with lower incomes, or experiencing financial strain were more likely to have material need insecurities (P < 0.05 for all). Among participants living in segregated jurisdictions, men had increased odds of food insecurity compared with women (odds ratio 3.7; 95% confidence interval, 1.61 to 8.53); younger participants (age <55 years) had increased odds of food insecurity compared with older participants (odds ratio 3.3; 95% confidence interval, 1.49 to 7.32). Associations between sex or younger age category and food insecurity were not statistically significant in less segregated counties (P interaction for residential segregation×sex: P = 0.006; residential segregation×younger age category: P = 0.12). Food insecurity, housing instability, and substance use were common among this sample of adults on hemodialysis. Younger adults on hemodialysis, particularly those living in residentially segregated jurisdictions, were at increased risk for food insecurity. Future research should examine whether material need insecurities perpetuate disparities in dialysis outcomes. This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/K360/2023_12_01_KID0000000000000279.mp3
影响因子：
3.9
作者：
Novick, Tessa K.;Osuna, Michelle;Crews, Deidra C.
通讯作者：
Crews, Deidra C.