Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Kidney Epidemiology and Cost Center, School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan.
Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Kidney Epidemiology and Cost Center, School of Public Health, University of Michigan, Ann Arbor, Michigan.
Am J Prev Med. 2017 Sep;53(3):300-307. doi: 10.1016/j.amepre.2017.02.015. Epub 2017 Apr 11.
This study examined state-level variation in chronic kidney disease (CKD) awareness using national estimates of disease awareness among adults in the U.S. with CKD.
Data on U.S. adults were obtained from two national, population-based surveys: (1) the Behavioral Risk Factor Surveillance System (BRFSS 2011; n=506,467), a state-level phone survey containing information on self-reported kidney disease; and (2) the National Health and Nutrition Examination Survey (NHANES 2005-2012; n=20,831), containing physical health examination, surveys containing data on self-reported kidney disease, risk factors, and laboratory values. CKD was defined as an estimated glomerular filtration rate of 15-59 mL/minute/1.73 m or urinary albumin-to-creatinine ratio >30 mg/g. As BRFSS does not include laboratory data, CKD status for each person was imputed (multiple) based on a logistic regression model predicting NHANES CKD status. CKD awareness in each state was estimated as the weighted proportion of BRFSS participants with imputed CKD who reported having kidney disease.
Overall, estimated CKD awareness was 9.0% (95% CI=8.0%, 10.0%), ranging from 5.8% (95% CI=4.8%, 6.8%) in Iowa to 11.7% (95% CI=9.7%, 13.7%) in Arizona. Awareness was greater among adults with hypertension (12.0%) and diabetes (15.3%) than among adults without those conditions, and lower in Hispanics (6.0%) than in non-Hispanic whites (8.8%), non-Hispanic blacks (9.9%), and other racial/ethnic groups (12.7%).
Among individuals with CKD, awareness of their condition was very low and varied approximately twofold among states. This is the first study to estimate awareness of kidney disease by state for the U.S. adult population.
本研究利用美国慢性肾脏病（CKD）患者的全国疾病知晓率数据，考察了各州 CKD 知晓率的差异。
本研究的数据来源于两项全国性的基于人群的调查：（1）行为风险因素监测系统（BRFSS 2011；n=506467），这是一项州级电话调查，包含了自我报告的肾脏疾病信息；（2）国家健康和营养调查（NHANES 2005-2012；n=20831），包含了体格检查、自我报告的肾脏疾病、危险因素和实验室值的调查。CKD 定义为估计肾小球滤过率 15-59ml/min/1.73m2 或尿白蛋白/肌酐比值>30mg/g。由于 BRFSS 不包含实验室数据，因此根据预测 NHANES CKD 状态的逻辑回归模型，对每个人的 CKD 状态进行了（多次）推断。每个州的 CKD 知晓率估计为 BRFSS 参与者中推断有 CKD 的、报告有肾脏疾病的人的加权比例。
总体而言，估计的 CKD 知晓率为 9.0%（95%CI=8.0%，10.0%），范围从爱荷华州的 5.8%（95%CI=4.8%，6.8%）到亚利桑那州的 11.7%（95%CI=9.7%，13.7%）。知晓率在高血压（12.0%）和糖尿病（15.3%）患者中高于无这些疾病的患者，在西班牙裔（6.0%）中低于非西班牙裔白人（8.8%）、非西班牙裔黑人（9.9%）和其他种族/民族群体（12.7%）。
在 CKD 患者中，对自身疾病的知晓率非常低，各州之间差异约为两倍。这是第一项估计美国成年人群体中各州肾脏疾病知晓率的研究。
