MedicalResearch: What is the background for this study? What are the main findings?
Dr. Kramer: The U.S. dialysis dependent population continues to grow with 636,905 prevalent cases of end-stage renal disease (ESRD) in the U.S. as of December 31, 2012, , an increase of 3.7% since 2011. Poverty is a well described risk factor for ESRD because poverty impacts access to care and nutritious foods. The definitions for poverty in the U.S. have not changed over the past several decades despite marked changes in social structure. For example, social integration in the U.S. society currently requires a cell phone, computer and internet access and access to transportation. Healthy foods also cost more now relative to unhealthy foods compared to past decades. Thus, the link between poverty and any chronic disease or health outcome is likely dynamic due to the evolving financial burden for living in a rapidly changing industrialized society. Our study defined poverty as living in a zip code defined area with > 20% of the residents living below the federal poverty line. We show that the prevalence of adults receiving dialysis who are living in poverty has increased over time. We also show that the association between poverty and ESRD may be getting stronger over time.
MedicalResearch: What should clinicians and patients take away from your report?
Dr. Kramer: Poverty remains highly prevalent among U.S. adults receiving dialysis and it now affects approximately 1 in 3 dialysis patients. Despite the rapidly changing society with cell phones, computer, and social media, the U.S. still uses the same basic definition for poverty that has been used for the past 50 years. We may be underestimating the negative impact of poverty on health outcomes such as kidney disease.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Dr. Kramer: Future studies should examine time trends in the association between individual measures of poverty or utilize census tracts for defining living in a poverty area.
Garrity, B. H., Kramer, H., Vellanki, K., Leehey, D., Brown, J. and Shoham, D. A. (2015), Time trends in the association of ESRD incidence with area-level poverty in the US population. Hemodialysis International. doi: 10.1111/hdi.12325