Low use of routine medical care among African Americans with high CKD risk: The Jackson Heart Study

Clarissa J. Diamantidis, Clemontina A. Davenport, Joseph Lunyera, Nrupen Bhavsar, Julia Scialla, Rasheeda Hall, Crystal Tyson, Mario Sims, Tara Strigo, Neil R. Powe, L. Ebony Boulware

Research output: Contribution to journalArticlepeer-review

Abstract

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 2 or urine albumin-to-creatinine ratio > 30 mg/g) or CKD risk factors (diabetes or hypertension). We used multivariable logistic regression to estimate the odds of low RMC use at baseline (2000-2004) for several risk factors. 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.

Original languageEnglish (US)
Article number11
JournalBMC nephrology
Volume20
Issue number1
DOIs
StatePublished - Jan 10 2019
Externally publishedYes

Keywords

  • Chronic kidney disease
  • Routine care
  • Trust

ASJC Scopus subject areas

  • Nephrology

Fingerprint

Dive into the research topics of 'Low use of routine medical care among African Americans with high CKD risk: The Jackson Heart Study'. Together they form a unique fingerprint.

Cite this