Spatial Distribution of Inequalities in End-Stage Renal Disease in the United States

Bilgel, Firat (2019). Science Direct



End-stage renal disease (ESRD) is the fifth and last stage of irreversible chronic kidney disease. Treatment requires renal replacement therapy either through dialysis or through kidney transplantation. The ESRD incidence rate in the US has grown by about 2.6% in the past two decades and, although a significant decline in this growth trajectory was achieved in the post-2006 period, about 691,000 patients were receiving treatment for ESRD at the end of 2015.

Many factors affect the progression of chronic kidney disease including socioeconomic status; genetic, racial, and behavioral risk factors; and healthcare access and availability. Prior studies have assumed that the effects of the main drivers of ESRD are constant across the United States. However, this is not necessarily the case. This paper uses spatial data analysis to examine the geographic relationship between ESRD prevalence and county characteristics including socioeconomic status and a variety of demographic and risk factors.

The exploratory spatial data analysis show a clear continental divide in the US, not only in terms of ESRD prevalence rates, but also in terms of every risk factor investigated. Poverty, income inequality, an increasingly uninsured population, and falling education levels are strongly associated with an increase in ESRD prevalence in the southeastern states, where the ESRD burden is already high. In contrast, behavioral risk factors such as obesity, diabetes, and binge drinking are strongly associated with an increase in ESRD prevalence in the Pacific states, where the burden of ESRD is relatively low. These results provide support for the implementation of location-specific approaches when attacking the problem of the ESRD burden in the US, rather than a one-size fits all approach.