Population-based interventions to reduce socioeconomic disparities in chronic kidney disease.
Disparities in the occurrence and outcomes of chronic kidney disease (CKD) are associated with individual and community socioeconomic (SES) risk factors. The pathways by which SES contribute to increased CKD risk are under active investigation and access to adequate health care appears to be an important contributor to these disparities. Changes in the US health system have eliminated barriers to access for end-stage renal disease care for most US citizens and reduced disparities in outcomes of care after the onset of renal replacement therapy. The purpose of this review is to summarize the empiric evidence for the association between SES and disparities in CKD occurrence and outcomes of care and to describe existing and planned interventions to reduce these SES-associated variations in CKD care. In particular, we describe a 10-state pilot project initiated by the Centers for Medicare and Medicaid Services in August of 2008 to reduce disparities and improve the detection and treatment of early diabetic kidney disease. This pilot project represents an important step in developing interventions to reduce CKD disparities in the US health care system.
McClellan
William M
WM
Department of Medicine and Epidemiology, Emory University, Atlanta, GA 30322, USA. wmcclel@sph.emory.edu
Casey
Mary Teresa
MT
Hughley
Jovonn
J
Freund
Eugene
E
D002908:Chronic Disease; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D007674:Kidney Diseases / Q000628:therapy*; D010865:Pilot Projects; D012959:Socioeconomic Factors