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Study looks at the impact of living conditions on kidney health among black patients
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A study looking at chronic kidney disease among black patients did not show a significant connection between neighborhood surroundings and a decline in kidney function. However, the elements that make up the living environment and its impact on CKD progression should be studied further, the authors agreed.
“It is well-documented that black adults have greater CKD compared to white adults and that, due to tremendously high levels of racial segregation in the U.S., black and white adults live in neighborhoods of very unequal quality,” said Margaret T. Hicken, MPH, PhD, of the Survey Research Center, Institute for Social Research at the University of Michigan, in a press release about the study. “I am hoping that these results reinforce the need to study the role of neighborhood context when it comes to racial inequalities in CKD,” Hicken said.
A growing body of literature indicates the quality of life in the residential neighborhood where one lives can impact disease risk, including the incidence and prevalence of many common risk factors for CKD, the authors wrote.
“Lower neighborhood socioeconomic status (SES) is associated with higher rates of hypertension, diabetes and obesity. Furthermore, residence in neighborhoods where persons report access to healthy food and spaces for physical activity is associated with lower risk for incident hypertension and diabetes, compared with neighborhoods where these are less available,” they wrote. “It is possible that aspects of neighborhood context important at earlier stages of CKD are not captured by neighborhood SES indicators. Residential neighborhoods serve as a source of economic and material resources, but they also serve as a source of social resources, constraints and stressors.”
Hicken and colleagues evaluated 10 years of data from 6,814 men and women who were between 45 and 84 years old and were free of cardiovascular disease. The patients were recruited between 2000 and 2002 from six major urban areas as part of the Multi-Ethnic Study of Atherosclerosis (MESA), a study designed to look at the progression of subclinical cardiovascular disease.
A composite “neighborhood problem” score was developed based on seven participant-reported domains when the participants entered the study: adequacy of food; availability of parks/playground, neighborhood noise; availability of sidewalks, neighborhood traffic; trash and litter; and violence. A social cohesion score was also created giving patient five choices in describing attributes of people in their neighborhood: close knit; get along; willing to help neighbors; trustworthy; and share values.
After questioning the patients to obtain a neighborhood problem score and a social cohesion score, researchers compared the results to the patient’s eGFR, creatinine and an indicator of eGFR decline of more than 30% since study entry, using follow-up eGFR quantified at four examinations (2000 to 2002, 2004 to 2005, 2005 to 2007 and 2010 to 2011).
The researchers looked for associations between each neighborhood measure and eGFR decline from baseline.
“We have realized over the past several years that genetic variance does not fully explain racial differences in kidney disease risk, and we cannot ignore the strong operative role of socioeconomic factors in health,” co-author Holly Mattix-Kramer, MD, MPH, of the department of nephrology and hypertension at Loyola University School of Medicine, said in the release.
The results indicate that, while neighborhood social context differs by race/ethnicity, “neither neighborhood problems nor social cohesion was independently associated with eGFR decline after adjustment for confounders,” the authors wrote. “Although we showed no independent association between neighborhood context and eGFR decline, it is associated with many CKD risk factors and further work is needed to clarify whether it has an independent role in CKD.”
Disclosures: The authors report no relevant financial disclosures. The study was supported by a career development award from the National Institute of Diabetes and Digestive and Kidney Diseases; from the National Heart, Lung, and Blood Institute, and from the National Center for Advancing Translational Sciences.
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