Despite National Declines In Kidney Failure Incidence, Disparities Widened Between Low- And High-Poverty US Counties

Kevin H Nguyen¹, Rebecca Thorsness², Shailender Swaminathan³, Rajnish Mehrotra⁴, Rachel E Patzer⁵, Yoojin Lee⁶, Daeho Kim⁷, Maricruz Rivera-Hernandez⁸, Amal N Trivedi⁹

Affiliations

¹ Kevin H. Nguyen (kevin_nguyen2@brown.edu) is an investigator in the Department of Health Services, Policy, and Practice, Brown University School of Public Health, in Providence, Rhode Island.
² Rebecca Thorsness is a research associate in the Department of Health Services, Policy, and Practice, Brown University School of Public Health, and a fellow in the Veterans Affairs New England Healthcare System, in Bedford, Massachusetts.
³ Shailender Swaminathan is a professor of economics and the dean of the Division of Social Sciences at Sai University, in Chennai, India.
⁴ Rajnish Mehrotra is the David S. and Nayda Utterberg Endowed Professor and interim head of the Division of Nephrology, University of Washington School of Medicine, in Seattle, Washington.
⁵ Rachel E. Patzer is a professor in the Department of Surgery and the Department of Epidemiology at the Emory University Rollins School of Public Health and director of the Health Services Research Center at the Emory University School of Medicine, in Atlanta, Georgia.
⁶ Yoojin Lee is a biostatistician in the Department of Health Services, Policy, and Practice, Brown University School of Public Health.
⁷ Daeho Kim is an adjunct assistant professor in the Department of Health Services, Policy, and Practice, Brown University School of Public Health.
⁸ Maricruz Rivera-Hernandez is an assistant professor in the Department of Health Services, Policy, and Practice, Brown University School of Public Health.
⁹ Amal N. Trivedi is a professor in the Department of Health Services, Policy, and Practice, Brown University School of Public Health, and a research health scientist at the Providence Veterans Affairs Medical Center, in Providence, Rhode Island.

PMID: 34871085
PMCID: PMC10076227
DOI: 10.1377/hlthaff.2021.00458

Despite National Declines In Kidney Failure Incidence, Disparities Widened Between Low- And High-Poverty US Counties

Kevin H Nguyen et al. Health Aff (Millwood). 2021 Dec.

. 2021 Dec;40(12):1900-1908.

doi: 10.1377/hlthaff.2021.00458.

Authors

Kevin H Nguyen¹, Rebecca Thorsness², Shailender Swaminathan³, Rajnish Mehrotra⁴, Rachel E Patzer⁵, Yoojin Lee⁶, Daeho Kim⁷, Maricruz Rivera-Hernandez⁸, Amal N Trivedi⁹

Affiliations

¹ Kevin H. Nguyen (kevin_nguyen2@brown.edu) is an investigator in the Department of Health Services, Policy, and Practice, Brown University School of Public Health, in Providence, Rhode Island.
² Rebecca Thorsness is a research associate in the Department of Health Services, Policy, and Practice, Brown University School of Public Health, and a fellow in the Veterans Affairs New England Healthcare System, in Bedford, Massachusetts.
³ Shailender Swaminathan is a professor of economics and the dean of the Division of Social Sciences at Sai University, in Chennai, India.
⁴ Rajnish Mehrotra is the David S. and Nayda Utterberg Endowed Professor and interim head of the Division of Nephrology, University of Washington School of Medicine, in Seattle, Washington.
⁵ Rachel E. Patzer is a professor in the Department of Surgery and the Department of Epidemiology at the Emory University Rollins School of Public Health and director of the Health Services Research Center at the Emory University School of Medicine, in Atlanta, Georgia.
⁶ Yoojin Lee is a biostatistician in the Department of Health Services, Policy, and Practice, Brown University School of Public Health.
⁷ Daeho Kim is an adjunct assistant professor in the Department of Health Services, Policy, and Practice, Brown University School of Public Health.
⁸ Maricruz Rivera-Hernandez is an assistant professor in the Department of Health Services, Policy, and Practice, Brown University School of Public Health.
⁹ Amal N. Trivedi is a professor in the Department of Health Services, Policy, and Practice, Brown University School of Public Health, and a research health scientist at the Providence Veterans Affairs Medical Center, in Providence, Rhode Island.

PMID: 34871085
PMCID: PMC10076227
DOI: 10.1377/hlthaff.2021.00458

Abstract

National estimates suggest that kidney failure incidence is declining in the US. However, whether this trend is evident in areas with socioeconomic disadvantage is unknown. We examined trends in kidney failure incidence by county-level poverty between 2000 and 2017 and divided the study period into period 1 (2000-05), period 2 (2006-11), and period 3 (2012-17). The magnitude of disparity in kidney failure incidence between high- and low-poverty counties increased from 42.8 more incident cases per million in high-poverty counties in period 1 to 100.1 more in period 3. Despite a national decline, kidney failure incidence increased in high-poverty counties, and disparities between high- and low-poverty counties widened from 2000 to 2017. Achieving the Department of Health and Human Services objective of reducing incident kidney failure cases by 25 percent by 2030 will require focused attention on preventing kidney failure in counties with higher poverty.

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**EXHIBIT 2. Trends in county-level all-cause kidney failure incidence per million US adults, by poverty quintile, 2000–17**
**SOURCE** Authors’ analyses of Medical Evidence Report data (form CMS 2728) and Census Bureau annual county population estimates, 2000–17. **NOTE** County-level kidney failure incidence rates are age and sex adjusted.

**EXHIBIT 3. Trends in county-level cause-specific kidney failure incidence per million US adults, by poverty quintile, 2000–17**
**SOURCE** Authors’ analyses of Medical Evidence Report data (form CMS 2728) and Census Bureau annual county population estimates between 2000–17. **NOTE** County-level kidney failure incidence rates are age and sex adjusted.

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References

1. US Renal Data System. US Renal Data System 2019 annual data report: epidemiology of kidney disease in the United States [Internet]. Bethesda (MD): USRDS; 2019. [cited 2021 Oct 1]. Available from: https://usrds.org/media/2371/2019-executive-summary.pdf
1. Vart P, Gansevoort RT, Joosten MM, BÜltmann U, Reijneveld SA. Socioeconomic disparities in chronic kidney disease: a systematic review and meta-analysis. Am J Prev Med. 2015;48(5):580–92. - PubMed
1. Nicholas SB, Kalantar-Zadeh K, Norris KC. Socioeconomic disparities in chronic kidney disease. Adv Chronic Kidney Dis. 2015;22(1):6–15. - PMC - PubMed
1. Norris K, Nissenson AR. Race, gender, and socioeconomic disparities in CKD in the United States. J Am Soc Nephrol. 2008;19(7):1261–70. - PubMed
1. Patzer RE, McClellan WM. Influence of race, ethnicity, and socioeconomic status on kidney disease. Nat Rev Nephrol 2012;8(9):533–41. - PMC - PubMed

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Despite National Declines In Kidney Failure Incidence, Disparities Widened Between Low- And High-Poverty US Counties

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Despite National Declines In Kidney Failure Incidence, Disparities Widened Between Low- And High-Poverty US Counties

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