Low use of routine medical care among African Americans with high CKD risk: the Jackson Heart Study.
Black or African American
/ psychology
Aged
Comorbidity
Diabetes Mellitus
/ ethnology
Female
Glomerular Filtration Rate
Humans
Hypertension
/ ethnology
Longitudinal Studies
Male
Middle Aged
Patient Acceptance of Health Care
/ ethnology
Prospective Studies
Psychology
Renal Insufficiency, Chronic
/ ethnology
Risk
Social Determinants of Health
Chronic kidney disease
Routine care
Trust
Journal
BMC nephrology
ISSN: 1471-2369
Titre abrégé: BMC Nephrol
Pays: England
ID NLM: 100967793
Informations de publication
Date de publication:
10 01 2019
10 01 2019
Historique:
received:
13
06
2018
accepted:
18
12
2018
entrez:
12
1
2019
pubmed:
12
1
2019
medline:
15
2
2020
Statut:
epublish
Résumé
Use of routine medical care (RMC) is advocated to address ethnic/racial disparities in chronic kidney disease (CKD) risks, but use is less frequent among African Americans. Factors associated with low RMC use among African Americans at risk of renal outcomes have not been well studied. We examined sociodemographic, comorbidity, healthcare access, and psychosocial (discrimination, anger, stress, trust) factors associated with low RMC use in a cross-sectional study. Low RMC use was defined as lack of a physical exam within one year among participants with CKD (estimated glomerular filtration rate < 60 mL/min/1.73m Among 3191 participants with CKD, diabetes, or hypertension, 2024 (63.4%) were ≥ 55 years of age, and 700 (21.9%) reported low RMC use. After multivariable adjustment, age < 55 years (OR 1.61 95% CI 1.31-1.98), male sex (OR 1.71; 1.41-2.07), <high school diploma (OR 1.31; 1.07-1.62), absence of hypertension (OR 1.74; 1.27-2.39) or diabetes (OR 1.34; 1.09-1.65), and tobacco use (OR 1.43; 1.18-1.72) were associated with low RMC use. Low trust in providers (OR 2.16; 1.42-3.27), high stress (OR 1.41; 1.09-1.82), high daily discrimination (OR 1.30; 1.01-1.67) and low burden of lifetime discrimination (OR 1.52; 1.18-1.94), were also associated with low RMC use. High-risk African Americans who were younger, male, less-educated, and with low trust in providers were more likely to report low RMC use. Efforts to improve RMC use by targeting these populations could mitigate African Americans' disparities in CKD risks.
Sections du résumé
BACKGROUND
Use of routine medical care (RMC) is advocated to address ethnic/racial disparities in chronic kidney disease (CKD) risks, but use is less frequent among African Americans. Factors associated with low RMC use among African Americans at risk of renal outcomes have not been well studied.
METHODS
We examined sociodemographic, comorbidity, healthcare access, and psychosocial (discrimination, anger, stress, trust) factors associated with low RMC use in a cross-sectional study. Low RMC use was defined as lack of a physical exam within one year among participants with CKD (estimated glomerular filtration rate < 60 mL/min/1.73m
RESULTS
Among 3191 participants with CKD, diabetes, or hypertension, 2024 (63.4%) were ≥ 55 years of age, and 700 (21.9%) reported low RMC use. After multivariable adjustment, age < 55 years (OR 1.61 95% CI 1.31-1.98), male sex (OR 1.71; 1.41-2.07), <high school diploma (OR 1.31; 1.07-1.62), absence of hypertension (OR 1.74; 1.27-2.39) or diabetes (OR 1.34; 1.09-1.65), and tobacco use (OR 1.43; 1.18-1.72) were associated with low RMC use. Low trust in providers (OR 2.16; 1.42-3.27), high stress (OR 1.41; 1.09-1.82), high daily discrimination (OR 1.30; 1.01-1.67) and low burden of lifetime discrimination (OR 1.52; 1.18-1.94), were also associated with low RMC use.
CONCLUSIONS
High-risk African Americans who were younger, male, less-educated, and with low trust in providers were more likely to report low RMC use. Efforts to improve RMC use by targeting these populations could mitigate African Americans' disparities in CKD risks.
Identifiants
pubmed: 30630437
doi: 10.1186/s12882-018-1190-0
pii: 10.1186/s12882-018-1190-0
pmc: PMC6327442
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
11Subventions
Organisme : NHLBI NIH HHS
ID : HHSN268201300048C
Pays : United States
Organisme : NHLBI NIH HHS
ID : HHSN268201300049C
Pays : United States
Organisme : NCATS NIH HHS
ID : KL2 TR001115
Pays : United States
Organisme : NHLBI NIH HHS
ID : HHSN268201300047C
Pays : United States
Organisme : NHLBI NIH HHS
ID : HHSN268201300050C
Pays : United States
Organisme : NHLBI NIH HHS
ID : HHSN268201300046C
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001117
Pays : United States
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