Journal Article

Incidence and Predictors of End Stage Renal Disease among Low-Income Blacks and Whites

Blot, William J., Lipworth, Loren, Ikizler, T. Alp, Edwards, Todd L., Mumma, Michael T., McLaughlin, Joseph K., Cavanaugh, Kerri L., E.Tarone, Robert

2012

Overview

We evaluated whether black race is associated with higher incidence of End Stage Renal Disease (ESRD) among a cohort of blacks and whites of similar, generally low socioeconomic status, and whether risk factor patterns differ among blacks and whites and explain the poorly understood racial disparity in ESRD. Incident diagnoses of ESRD among 79,943 black and white participants in the Southern Community Cohort Study (SCCS) were ascertained by linkage with the United States Renal Data System (USRDS) from 2002 through 2009. Person-years of follow up were calculated from date of entry into the SCCS until date of ESRD diagnosis, date of death, or September 1, 2009, whichever occurred first. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for incident ESRD among black and white participants in relation to baseline characteristics. After 329,003 person-years of follow-up, 687 incident cases of ESRD were identified in the cohort. The age-adjusted ESRD incidence rate was 273 (per 100,000) among blacks, 3.5-fold higher than the rate of 78 among whites. Risk factors for ESRD included male sex (HR = 1.6; 95% CI 1.4-1.9), low income (HR = 1.5; 95% CI 1.2-1.8 for income below vs. above $15,000), smoking (HR = 1.2; 95% CI 1.02-1.4) and histories of diabetes (HRs increasing to 9.4 (95% CI 7.4-11.9) among those with ≥20 years diabetes duration) and hypertension (HR = 2.9; 95% CI 2.3-3.7). Patterns and magnitudes of association were virtually identical among blacks and whites. After adjustment for these risk factors, blacks continued to have a higher risk for ESRD (HR = 2.4; 95% CI = 1.9-3.0) relative to whites. The black-white disparity in risk of ESRD was attenuated but not eliminated after control for known risk factors in a closely socioeconomically matched cohort. Further research characterizing biomedical factors, including CKD progression, in ESRD occurrence in these two racial groups is needed.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adult / African Americans / African Continental Ancestry Group / Age / Age Distribution / Aged / Biology / Black people / Cancer / Chronic kidney failure / Confidence intervals / Data systems / Development and progression / Diabetes / Diabetes mellitus / Epidemiology / European Continental Ancestry Group / Family medical history / Hazards / Health risk assessment / Hemodialysis / Humans / Hypertension / Incidence / Income / Kidney diseases / Kidney Failure, Chronic - epidemiology / Kidney Failure, Chronic - ethnology / Kidney transplantation / Low income groups / Medicare / Medicine / Middle Aged / Nephrology / Nutrition research / Personal income / Population / Questionnaires / Race factors / Risk analysis / Risk factors / Risk management / Smoking / Social security / Socioeconomic Factors / Socioeconomics / Statistical models / Studies