Living conditions in the ‘stroke belt’ of the US pose a novel risk of CKD
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Key takeaways:
- Black individuals had a higher incidence of CKD vs. white individuals.
- Systolic blood pressure, diabetes, heart disease and BMI were CKD risk factors.
Living conditions in the southeastern region of the United States, known as the “stroke belt” for its higher incidence of stroke among the population, pose a novel risk of chronic kidney disease, a recently published study shows.
“Compared with the rest of the United States, residents in the southeast may experience differences in environmental exposures such as heat, air pollution or water quality, which have each been linked to kidney disease,” Katharine L. Cheung, MD, PhD, an assistant professor of medicine in the division of nephrology at the University of Vermont, and colleagues wrote.
Investigators aimed to uncover differences in CKD risk factors based on geographic region, gender and race. In addition to finding higher CKD incidence in Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, South Carolina and Tennessee, where there is a high burden of strokes, researchers said the study showed a greater risk for developing or worsening CKD in Black adults vs. white adults.
The observational cohort study followed 4,198 Black and 7,799 white U.S. participants, recruited from 2003 through 2007, with baseline eGFR above 60 mL/min/1.73 m2. In telephone interviews, participants reported demographic characteristics, cardiovascular risk factors and medication data. They underwent an initial in-home visit where researchers collected anthropometric data, followed by 6-month follow-ups.
Exposures included education, income, systolic blood pressure, BMI, diabetes, coronary heart disease, hyperlipidemia, smoking and albuminuria. Researchers used linear and modified regression models to determine the link between risk factors and CKD. According to the analysis, 9% of participants developed CKD during the study, “ranging from 4% of those 45 to 54 years old to 18% of those at least 75 years old,” the researchers wrote.
Systolic blood pressure, diabetes, heart disease and BMI were all CKD risk factors. “[S]troke belt residence was independently associated with eGFR change,” the researchers wrote.
Black individuals had a higher incidence of CKD vs. white individuals, overall; however, the disparity diminished after accounting for traditional CKD risk factors. Albuminuria was also more strongly linked with eGFR decrease and CKD in Black individuals.
“Our results also add to the available literature by newly identifying residence in the U.S. stroke belt as a risk factor for the development of incident CKD and eGFR decrease,” the authors wrote. “Future research should work to determine these factors ... to reduce the excess burden of CKD and kidney failure requiring replacement therapy.”
Perspective
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The South, and the state of Alabama in particular, is so much more than magnolias and football. It is an area that clings to tradition but also welcomes change. It can boast of outstanding universities and medical centers yet ranks as one of the unhealthiest regions in the country.
A review of the Reasons for Geographic and Racial Differences in Stroke study highlights the impact of poor health habits as risk factors of CKD. By almost every measure, Alabama ranked highest in incidence of negative health factors. Here are some highlights. Smoking is a known risk factor for many conditions other than cancer. Of the states with the highest number of smokers, most are in the South. West Virginia has the highest rate with 26% of its population who smoke; Alabama has 21%. Alabama also leads the nation in obesity. Approximately 40% of the population in the state has a BMI qualifying as obese. The American Diabetes Association estimates that 14.4% of the population in the United States has diabetes, while approximately 119,000 individuals are undiagnosed. A study by the University of Alabama at Birmingham found 1:6 Americans has ideal cardiovascular health; in the South, only 1:10 make the list. In ranking CVD by population, Alabama ranked 47th. Education level correlates with health status. Of the 10 states with the lowest levels of attainment, seven were in the South. Alabama ranked 45th.
Ten states did not expand Medicaid when it became available. Seven of those were Southern states, and Alabama was among these. The South has work to do in slowing the progression of CKD. Increased attention to health factors is a good place to start.
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