Xu Fang, Miyamoto Yoshihisa, Zaganjor Ibrahim, Onufrak Stephen, Saelee Ryan, Koyama Alain K, Pavkov Meda E
Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Am J Prev Med. 2025 Jan;68(1):31-38. doi: 10.1016/j.amepre.2024.08.009. Epub 2024 Aug 22.
Acute kidney injury (AKI) is associated with increased mortality. AKI-related mortality trends by U.S. urban and rural counties were assessed.
In the cross-sectional study, based on the Centers for Disease Control and Prevention WONDER (Wide-ranging ONline Data for Epidemiologic Research) Multiple Cause of Death data, age-standardized mortality with AKI as the multiple cause was obtained among adults aged ≥25 years from 2001-2020, by age, sex, race and ethnicity, stratified by urban-rural counties. Joinpoint regressions were used to assess trends from 2001-2019 in AKI-related mortality rate. Pairwise comparison was used to compare mean differences in mortality between urban and rural counties from 2001-2019.
From 2001-2020, age-standardized AKI-related mortality was consistently higher in rural than urban counties. AKI-related mortality (per 100,000 population) increased from 18.95 in 2001 to 29.46 in 2020 in urban counties and from 20.10 in 2001 to 38.24 in 2020 in rural counties. In urban counties, AKI-related mortality increased annually by 4.6% during 2001-2009 and decreased annually by 1.8% until 2019 (p<0.001). In rural counties, AKI-related mortality increased annually by 5.0% during 2001-2011 and decreased by 1.2% until 2019 (p<0.01). The overall urban-rural difference in AKI-related mortality was greater after 2009-2011. AKI-related mortality was significantly higher among older adults, men, and non-Hispanic Black adults than their counterparts in both urban and rural counties. Higher mortality was concentrated in rural counties in the Southern United States.
Multidisciplinary efforts are needed to increase AKI awareness and implement strategies to reduce AKI-related mortality in rural and high-risk populations.
急性肾损伤（AKI）与死亡率增加相关。本研究评估了美国城乡县的AKI相关死亡率趋势。
在这项横断面研究中，基于疾病控制与预防中心的WONDER（广泛在线流行病学研究数据）多死因数据，于2001年至2020年期间，按年龄、性别、种族和民族，从≥25岁的成年人中获取以AKI作为多死因的年龄标准化死亡率，并按城乡县进行分层。采用连接点回归评估2001年至2019年AKI相关死亡率的趋势。采用成对比较来比较2001年至2019年城乡县之间死亡率的平均差异。
2001年至2020年期间，农村地区年龄标准化的AKI相关死亡率始终高于城市地区。城市县中，AKI相关死亡率（每10万人）从2001年的18.95上升至2020年的29.46，农村县则从2001年的20.10上升至2020年的38.24。在城市县，2001年至2009年期间AKI相关死亡率每年上升4.6%，至2019年每年下降1.8%（p<0.001）。在农村县，2001年至2011年期间AKI相关死亡率每年上升5.0%，至2019年下降1.2%（p<0.01）。2009年至2011年后，城乡AKI相关死亡率的总体差异更大。在城市和农村县，老年人、男性和非西班牙裔黑人成年人的AKI相关死亡率显著高于相应人群。较高的死亡率集中在美国南部的农村县。
需要多学科努力，以提高对AKI的认识，并实施策略来降低农村和高危人群中与AKI相关的死亡率。
