Details:

Alternative Title:
PLoS One
Personal Author:
Bragg-Gresham, Jennifer ; Morgenstern, Hal ; McClellan, William ; Saydah, Sharon ; Pavkov, Meda ; ... More +
Bragg-Gresham, Jennifer ; Morgenstern, Hal ; McClellan, William ; Saydah, Sharon ; Pavkov, Meda ; Williams, Desmond ; Powe, Neil ; Tuot, Delphine ; Hsu, Raymond ; Saran, Rajiv Less -
Corporate Authors:
for the Centers for Disease Control and Prevention CKD Surveillance System
Description:
Background

Considerable geographic variation exists in the prevalence of chronic kidney disease across the United States. While some of this variability can be explained by differences in patient-level risk factors, substantial variability still exists. We hypothesize this may be due to understudied environmental exposures such as air pollution.

Methods

Using data on 1.1 million persons from the 2010 5% Medicare sample and Environmental Protection Agency air-quality measures, we examined the association between county-level particulate matter ≤2.5 μm (PM2.5) and the prevalence of diagnosed CKD, based on claims. Modified Poisson regression was used to estimate associations (prevalence ratios [PR]) between county PM2.5 concentration and individual-level diagnosis of CKD, adjusting for age, sex, race/ethnicity, hypertension, diabetes, and urban/rural status.

Results

Prevalence of diagnosed CKD ranged from 0% to 60% by county (median = 16%). As a continuous variable, PM2.5 concentration shows adjusted PR of diagnosed CKD = 1.03 (95% CI: 1.02–1.05; p<0.001) for an increase of 4 μg/m3 in PM2.5. Investigation by quartiles shows an elevated prevalence of diagnosed CKD for mean PM2.5 levels ≥14 μg/m3 (highest quartile: PR = 1.05, 95% CI: 1.03–1.07), which is consistent with current ambient air quality standard of 12 μg/m3, but much lower than the level typically considered healthy for sensitive groups (~40 μg/m3).

Conclusion

A positive association was observed between county-level PM2.5 concentration and diagnosed CKD. The reliance on CKD diagnostic codes likely identified associations with the most severe CKD cases. These results can be strengthened by exploring laboratory-based diagnosis of CKD, individual measures of exposure to multiple pollutants, and more control of confounding.


Subjects:
[+]
Aged Aged, 80 And Over Air Pollutants Cross-Sectional Studies Environmental Exposure Female Humans Male Medicare Particulate Matter Prevalence Renal Insufficiency, Chronic Risk Assessment
Source:
PLoS One. 13(7).
Pubmed ID:
30063741
Pubmed Central ID:
PMC6067706
Document Type:
Journal Article
Name as Subject:
United States. Environmental Protection Agency.
Place as Subject:
United States
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:4f5eb690af16550add3463fb6a063746e171e15ef99c9736ec8b13f7eebc198e
Download URL:
https://stacks.cdc.gov/view/cdc/58246/cdc_58246_DS1.pdf
File Type:

Supporting Files

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