Poverty and racial disparities in kidney disease: the REGARDS study.
There are pronounced disparities among black compared to white Americans for risk of end-stage renal disease. This study examines whether similar relationships exist between poverty and racial disparities in chronic kidney disease (CKD) prevalence.


METHODS
We studied 22,538 participants in the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort study. We defined individual poverty as family income below USD 15,000 and a neighborhood as poor if 25% or more of the households were below the federal poverty level.


RESULTS
As the estimated glomerular filtration rate (GFR) declined from 50-59 to 10-19 ml/min/ 1.73 m2, the black:white odds ratio (OR) for impaired kidney function increased from 0.74 (95% CI 0.66, 0.84) to 2.96 (95% CI 1.96, 5.57). Controlling for individual income below poverty, community poverty, demographic and comorbid characteristics attenuated the black:white prevalence to an OR of 0.65 (95% CI 0.57, 0.74) among individuals with a GFR of 59-50 ml/min/1.73 m2 and an OR of 2.21 (95% CI 1.25, 3.93) among individuals with a GFR between 10 and 19 ml/min/ 1.73 m2.


CONCLUSIONS
Household, but not community poverty, was independently associated with CKD and attenuated but did not fully account for differences in CKD prevalence between whites and blacks.
McClellan
William M
WM
Renal Division, Emory University School of Medicine, Atlanta, GA 30322, USA. wmcclel@sph.emory.edu
Newsome
Britt B
BB
McClure
Leslie A
LA
Howard
George
G
Volkova
Nataliya
N
Audhya
Paul
P
Warnock
David G
DG
D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000706:statistics & numerical data*; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000191:economics / Q000208:ethnology*; D012307:Risk Factors; D012720:Severity of Illness Index; D044465:White People / Q000706:statistics & numerical data*
D003404:Creatinine