Department of Medicine and Epidemiology, Emory University, Atlanta, GA 30322, USA.
Semin Nephrol. 2010 Jan;30(1):33-41. doi: 10.1016/j.semnephrol.2009.10.011.
Disparities in the occurrence and outcomes of chronic kidney disease (CKD) are associated with individual and community socioeconomic (SES) risk factors. The pathways by which SES contribute to increased CKD risk are under active investigation and access to adequate health care appears to be an important contributor to these disparities. Changes in the US health system have eliminated barriers to access for end-stage renal disease care for most US citizens and reduced disparities in outcomes of care after the onset of renal replacement therapy. The purpose of this review is to summarize the empiric evidence for the association between SES and disparities in CKD occurrence and outcomes of care and to describe existing and planned interventions to reduce these SES-associated variations in CKD care. In particular, we describe a 10-state pilot project initiated by the Centers for Medicare and Medicaid Services in August of 2008 to reduce disparities and improve the detection and treatment of early diabetic kidney disease. This pilot project represents an important step in developing interventions to reduce CKD disparities in the US health care system.
慢性肾脏病（CKD）的发生和结局存在差异，与个体和社区社会经济（SES）风险因素有关。SES 促进 CKD 风险增加的途径正在积极研究中，获得足够的医疗保健似乎是造成这些差异的一个重要因素。美国医疗体系的变化消除了大多数美国公民接受终末期肾脏疾病治疗的障碍，并在开始肾脏替代治疗后减少了护理结果的差异。本综述的目的是总结 SES 与 CKD 发生和护理结局差异之间关联的经验证据，并描述现有的和计划中的干预措施，以减少 CKD 护理中与 SES 相关的这些差异。特别是，我们描述了 2008 年 8 月医疗保险和医疗补助服务中心发起的一个由 10 个州参与的试点项目，以减少差异，并改善早期糖尿病肾病的检测和治疗。该试点项目是在美国医疗保健系统中制定减少 CKD 差异干预措施的重要步骤。
