Bowe Benjamin, Xie Yan, Xian Hong, Lian Min, Al-Aly Ziyad
Clinical Epidemiology Center, Research and Education Service, VA Saint Louis Health Care System, Saint Louis, Missouri, USA.
Department of Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri, USA.
Kidney Int Rep. 2016 Aug 30;2(1):5-17. doi: 10.1016/j.ekir.2016.08.016. eCollection 2017 Jan.
Geographic variation in the prevalence of chronic kidney disease and incidence of end-stage renal disease has been previously reported. However, the geographic epidemiology of rapid estimated glomerular filtration rate (eGFR) decline has not been examined.
We built a longitudinal cohort of 2,107,570 US veterans to characterize the spatial epidemiology of and examine the associations between US county characteristics and rapid eGFR decline.
There were 169,029 (8.02%) with rapid eGFR decline (defined as eGFR slope < -5 ml/min per 1.73 m/year). The prevalence of rapid eGFR decline adjusted for age, race, gender, diabetes, and hypertension varied by county from 4.10%-6.72% in the lowest prevalence quintile to 8.41%-22.04% in the highest prevalence quintile ( for heterogeneity < 0.001). Examination of adjusted prevalence showed substantial geographic variation in those with and without diabetes and those with and without hypertension ( for heterogeneity < 0.001). Cohort participants had higher odds of rapid eGFR decline when living in counties with unfavorable characteristics in domains including health outcomes (odds ratio [OR] = 1.15; confidence interval [CI] = 1.09-1.22), health behaviors (OR = 1.08; CI = 1.03-1.13), clinical care (OR = 1.11; CI = 1.06-1.16), socioeconomic conditions (OR = 1.15; CI = 1.09-1.22), and physical environment (OR = 1.15; CI = 1.01-1.20); living in counties with high percentage of minorities and immigrants was associated with rapid eGFR decline (OR = 1.25; CI = 1.20-1.31). Spatial analyses suggest the presence of cluster of counties with high prevalence of rapid eGFR decline.
Our findings show substantial geographic variation in rapid eGFR decline among US veterans; the variation persists in analyses stratified by diabetes and hypertension status; results show associations between US county characteristics in domains capturing health, socioeconomic, environmental, and diversity conditions, and rapid eGFR decline.
先前已有报道称慢性肾脏病患病率和终末期肾病发病率存在地域差异。然而，肾小球滤过率估算值（eGFR）快速下降的地域流行病学情况尚未得到研究。
我们建立了一个包含2107570名美国退伍军人的纵向队列，以描述美国县域特征与eGFR快速下降之间的空间流行病学特征并检验二者之间的关联。
有169029人（8.02%）出现eGFR快速下降（定义为eGFR斜率<-5 ml/min/1.73m²/年）。经年龄、种族、性别、糖尿病和高血压校正后的eGFR快速下降患病率在各县之间有所不同，患病率最低的五分之一地区为4.10%-6.72%，患病率最高的五分之一地区为8.41%-22.04%（异质性P<0.001）。对校正患病率的分析显示，有糖尿病和无糖尿病者以及有高血压和无高血压者存在显著的地域差异（异质性P<0.001）。队列参与者若居住在健康结局（优势比[OR]=1.15；置信区间[CI]=1.09-1.22）、健康行为（OR=1.08；CI=1.03-1.13）、临床护理（OR=1.11；CI=1.06-1.16）、社会经济状况（OR=1.15；CI=1.09-1.22）和物理环境（OR=1.15；CI=1.01-1.20）等领域特征不利的县，其eGFR快速下降的几率更高；居住在少数民族和移民比例高的县与eGFR快速下降相关（OR=1.25；CI=1.20-1.31）。空间分析表明存在eGFR快速下降患病率高的县的聚集区。
我们的研究结果表明，美国退伍军人中eGFR快速下降存在显著的地域差异；在按糖尿病和高血压状态分层的分析中，这种差异依然存在；结果显示，在涵盖健康、社会经济、环境和多样性状况的领域中，美国县域特征与eGFR快速下降之间存在关联。
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