Including socioeconomic status in CKD screening leads to ‘modest’ increase in detection
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Adding consideration of socioeconomic status to a standard screening approach for chronic kidney disease “modestly” increased rates of detection in terms of sensitivity, although this approach also resulted in decreased specificity.
“Screening for chronic kidney disease (CKD) is recommended for patients with diabetes and hypertension as stated by their respective societies,” Lama Ghazi, MD, PhD, of University of Minnesota, and colleagues wrote. “However, CKD, a silent disease usually detected at later stages, is associated with low socioeconomic status (SES). We assessed whether adding census tract SES status to the standard screening approach improves our ability to identify patients with CKD.”
For the study, researchers extracted residential addresses from the electronic health records of 256,162 patients in the Minneapolis/St. Paul area.
Considered exposures included:
- first quartile of census tract SES (defined as the median value of owner-occupied housing units being less than $165,200);
- average household income of less than $35,935;
- percentage of residents aged older than 25 years with a bachelor’s or higher degree; and
- hypertension and diabetes.
Determining that CKD was prevalent in 13% of the cohort, they compared sensitivity, specificity and number needed to screen (NNS) to detect CKD between a standard approach and one that included tract SES.
For the standard approach, researchers determined sensitivity of detecting CKD to be 60%, sensitivity to be 73% and NNS to be four. Adding tract SES resulted in increased sensitivity for detecting CKD (67%), but decreased specificity and NNS (61% and five, respectively).
“An approach that screens the overall cohort by hypertension and/or DM [diabetes mellitus] and/or SES has a higher sensitivity (67%) and lower specificity (61%) than that obtained by the traditional approach in the high and low SES tracts,” Ghazi and colleagues wrote. “Therefore, based on our findings we are unable to recommend adding area-level SES to hypertension and diabetes to screen for CKD on the population level.”
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