County-level air quality and the prevalence of diagnosed chronic kidney disease in the US Medicare population
Open Access
- 31 July 2018
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 13 (7), e0200612
- https://doi.org/10.1371/journal.pone.0200612
Abstract
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 mu m (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= 14 mu g/m(3) (highest quartile: PR = 1.05, 95% CI: 1.03-1.07), which is consistent with current ambient air quality standard of 12 mu g/m 3 , but much lower than the level typically considered healthy for sensitive groups (similar to 40 mu g/m(3)). 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.Keywords
Funding Information
- Centers for Disease Control and Prevention (U58 DP006254)
This publication has 47 references indexed in Scilit:
- The Economics of Food Choice Behavior: Why Poverty and Obesity Are LinkedNestle Nutrition Institute workshop series, 2012
- The contribution of chronic kidney disease to the global burden of major noncommunicable diseasesKidney International, 2011
- Validation of CKD and Related Conditions in Existing Data Sets: A Systematic ReviewAmerican Journal of Kidney Diseases, 2011
- Ambient Air Pollution Exaggerates Adipose Inflammation and Insulin Resistance in a Mouse Model of Diet-Induced ObesityCirculation, 2009
- Chronic kidney disease as a global public health problem: Approaches and initiatives – a position statement from Kidney Disease Improving Global OutcomesKidney International, 2007
- Lead-related nephrotoxicity: A review of the epidemiologic evidenceKidney International, 2006
- Renin-Angiotensin-Aldosterone System and Progression of Renal DiseaseJournal of the American Society of Nephrology, 2006
- Epidemiology of Fine Particulate Air Pollution and Human Health: Biologic Mechanisms and Who's at Risk?Environmental Health Perspectives, 2000
- Air pollution and asthmaJournal of Allergy and Clinical Immunology, 1999
- Particulate Air Pollution and Chronic Respiratory DiseaseEnvironmental Research, 1993