Division of Kidney Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892-5458, USA.
J Am Soc Nephrol. 2013 Feb;24(2):293-301. doi: 10.1681/ASN.2012070659. Epub 2013 Jan 18.
Social and ecologic factors, such as residential segregation, are determinants of health in the general population, but how these factors associate with outcomes among patients with ESRD is not well understood. Here, we examined associations of income inequality and residence, as social determinants of health, with survival among black and white patients with ESRD. We merged U.S. Renal Data System data from 589,036 patients who started hemodialysis from 2000 through 2008 with race-specific median household income data from the Census Bureau. We used Gini Index coefficients to assess income distributional inequality and the Dissimilarity Index to determine residential segregation. Black patients lived in areas of lower median household income compared with white patients ($26,742 versus $41,922; P<0.001). Residence in areas with higher median household income was associated with improved survival. Among whites, income inequality was associated with mortality. Among blacks exclusively, residence in highly segregated areas was associated with increased mortality. In conclusion, black hemodialysis patients in the United States are particularly susceptible to gradients in income and residential segregation. Interventions directed at highly segregated black neighborhoods might favorably affect hemodialysis patient outcomes.
社会和生态因素，如居住隔离，是一般人群健康的决定因素，但这些因素与终末期肾病患者的结果有何关联尚不清楚。在这里，我们研究了健康的社会决定因素，即收入不平等和居住地，与接受血液透析的黑人和白人患者的存活率之间的关联。我们将美国肾脏数据系统 2000 年至 2008 年间开始血液透析的 589036 名患者的数据与人口普查局的种族特异性家庭中位数收入数据进行了合并。我们使用基尼系数评估收入分配不平等，使用不相似指数确定居住隔离程度。与白人患者相比，黑人患者居住在家庭中位数收入较低的地区（26742 美元比 41922 美元；P<0.001）。居住在家庭中位数收入较高的地区与生存率提高有关。在白人中，收入不平等与死亡率有关。而在黑人中，居住在高度隔离的地区与死亡率增加有关。总之，美国的黑人血液透析患者特别容易受到收入和居住隔离梯度的影响。针对高度隔离的黑人社区的干预措施可能会对血液透析患者的结果产生有利影响。
