title: Race differences in access to health care and disparities in incident chronic kidney disease in the US.
abstract: BACKGROUND
  The contribution of race differences in access to health care to disparities in chronic kidney disease (CKD) incidence in the United States is unknown.
  
  
  METHODS
  We examined race differences in usual source of health care, health insurance and CKD incidence among 3883 Whites and 1607 Blacks with hypertension or diabetes enrolled in the Atherosclerosis Risk in Communities Study. In multivariable analyses, we explored the incremental contribution of access to health care in explaining Blacks' excess CKD incidence above and beyond other socioeconomic, lifestyle and clinical factors.
  
  
  RESULTS
  Compared with Whites, Blacks had poorer access to health care (3 vs 0.3% with no usual source of health care or health insurance, P < 0.001) and experienced greater CKD incidence (14.7 vs 12.0 cases per 1000 person-years, P < 0.001). Blacks' excess risk of CKD persisted after adjusting for demographic, socioeconomic, lifestyle and clinical factors [hazard ratio (HR) (95% confidence interval (95% CI)) = 1.21 (1.01-1.47)]. Adjustment for these factors explained 64% of the excess risk among Blacks. The increased risk for CKD among Blacks was attenuated after additional adjustment for race differences in access to health care [HR (95% CI) = 1.19 (0.99-1.45)], which explained an additional 10% of the disparity. Conclusions. In this population at risk for developing CKD, we found that poorer access to health care among Blacks explained some of Blacks' excess risk of CKD, beyond the excess risk explained by demographic, socioeconomic, lifestyle and clinical factors. Improved access to health care for high-risk individuals could narrow disparities in CKD incidence.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. kira.e.evans@gmail.com
authors.forename: Kira
authors.initials: K
authors.lastname: Evans
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.forename: Lori D
authors.initials: LD
authors.lastname: Bash
authors.forename: Tiffany
authors.initials: T
authors.lastname: Gary-Webb
authors.forename: Anna
authors.initials: A
authors.lastname: Köttgen
authors.forename: Kathryn
authors.initials: K
authors.lastname: Carson
authors.forename: L Ebony
authors.initials: LE
authors.lastname: Boulware
mesh_terms: D044383:Black People / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000628:therapy; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000458:organization & administration*; D006801:Humans; D006973:Hypertension / Q000628:therapy; D015994:Incidence; D007348:Insurance, Health; D007676:Kidney Failure, Chronic / Q000208:ethnology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012959:Socioeconomic Factors; D014481:United States; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American