Received August 28, 2006
Accepted on August 9, 2007

CLINICAL EPIDEMIOLOGY

Neighborhood Poverty and Racial Differences in ESRD Incidence

Nataliya Volkova ^*1, William McClellan ^*, Mitchel Klein ^*, Dana Flanders ^*, David Kleinbaum ^*, J. Michael Soucie ^*, and Rodney Presley

*Rollins School of Public Health, Emory University, and Georgia Medical Care Foundation, Atlanta, Georgia

¹ To whom correspondence should be addressed. E-mail: nvolkov{at}alum.emory.edu.

	Abstract

Poverty is associated with increased risk of ESRD, but its contribution to observed racial differences in disease incidence is not well-defined. To explore the contribution of neighborhood poverty to racial disparity in ESRD incidence, we analyzed a combination of US Census and ESRD Network 6 data comprising 34,767 patients that initiated dialysis in Georgia, North Carolina, or South Carolina between January 1998 and December 2002. Census tracts were used as the geographic units of analysis, and the proportion of the census tract population living below the poverty level was our measure of neighborhood poverty. Incident ESRD rates were modeled using two-level Poisson regression, where race, age and gender were individual covariates (level 1), and census tract poverty was a neighborhood covariate (level 2). Neighborhood poverty was strongly associated with higher ESRD incidence for both blacks and whites. Increasing poverty was associated with a greater disparity in ESRD rates between blacks and whites, with the former at greater risk. This raises the possibility that blacks may suffer more from lower socioeconomic conditions than whites. The disparity persisted across all poverty levels. The reasons for increasingly higher ESRD incidence among US blacks as neighborhood poverty increases remain to be explained.