Norton Jenna M, Grunwald Lindsay, Banaag Amanda, Olsen Cara, Narva Andrew S, Marks Eric, Koehlmoos Tracey P
Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD.
Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD.
Kidney Med. 2021 Oct 23;4(1):100381. doi: 10.1016/j.xkme.2021.08.015. eCollection 2022 Jan.
RATIONALE & OBJECTIVE: Health-impeding social determinants of health-including reduced access to care-contribute to racial and socioeconomic disparities in chronic kidney disease (CKD). The Military Health System (MHS) provides an opportunity to assess a large, diverse population for CKD disparities in the context of universal health care.
Cross-sectional study.
SETTING & PARTICIPANTS: MHS beneficiaries aged 18 to 64 years receiving care between October 1, 2015, and September 30, 2018.
Race, sponsor's rank (a proxy for socioeconomic status and social class), median household income by sponsor's zip code, and marital status.
CKD prevalence, defined by codes and/or a validated, laboratory value-based electronic phenotype.
Multivariable logistic regression compared CKD prevalence by predictors, controlling separately for confounders (age, sex, active-duty status, sponsor's service branch, and depression) and mediators (hypertension, diabetes, HIV, and body mass index).
Of 3,330,893 beneficiaries, 105,504 (3.2%) had CKD. In confounder-adjusted models, the CKD prevalence was higher in Black versus White beneficiaries (OR, 1.67; 95% CI, 1.64-1.70), but lower in single versus married beneficiaries (OR, 0.77; 95% CI, 0.76-0.79). The prevalence of CKD was increased among those with a lower military rank and among those with a lower median household income in a nearly dose-response fashion ( < 0.0001). Associations were attenuated when further adjusting for suspected mediators.
The cross-sectional design prevents causal inferences. We may have underestimated the CKD prevalence, given a lack of data for laboratory tests conducted outside the MHS and the use of a specific CKD definition. The transient nature of the MHS population may limit the accuracy of zip code-level median household income data.
Racial and socioeconomic CKD disparities exist in the MHS despite universal health care coverage. The existence of CKD disparities by rank and median household income suggests that social risks may contribute to both racial and socioeconomic disparities despite access to universal health care coverage.
阻碍健康的社会决定因素，包括获得医疗服务的机会减少，导致慢性肾脏病（CKD）存在种族和社会经济差异。军事医疗系统（MHS）提供了一个机会，可在全民医保背景下评估大量不同人群中的CKD差异。
横断面研究。
2015年10月1日至2018年9月30日期间接受治疗的18至64岁的MHS受益人。
种族、担保人职级（社会经济地位和社会阶层的代表）、担保人邮政编码对应的家庭收入中位数以及婚姻状况。
CKD患病率，通过编码和/或经过验证的基于实验室值的电子表型定义。
多变量逻辑回归按预测因素比较CKD患病率，分别控制混杂因素（年龄、性别、现役状态、担保人军种和抑郁症）和中介因素（高血压、糖尿病、艾滋病毒和体重指数）。
在3330893名受益人中，105504人（3.2%）患有CKD。在调整混杂因素的模型中，黑人受益人的CKD患病率高于白人受益人（OR，1.67；95%CI，1.64 - 1.70），但单身受益人低于已婚受益人（OR，0.77；95%CI，0.76 - 0.79）。CKD患病率在军阶较低和家庭收入中位数较低的人群中以近似剂量反应的方式增加（P < 0.0001）。在进一步调整可疑中介因素后，关联减弱。
横断面设计无法进行因果推断。由于缺乏MHS以外进行的实验室检查数据以及使用特定的CKD定义，我们可能低估了CKD患病率。MHS人群的短暂性可能会限制邮政编码级家庭收入中位数数据的准确性。
尽管有全民医保覆盖，MHS中仍存在种族和社会经济的CKD差异。按职级和家庭收入中位数存在的CKD差异表明尽管有全民医保覆盖，但社会风险可能导致种族和社会经济差异。
