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Clinical Research
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Neighborhood Socioeconomic Status, Race, and Mortality in Young Adult Dialysis Patients

Tanya S. Johns, Michelle M. Estrella, Deidra C. Crews, Lawrence J. Appel, Cheryl A.M. Anderson, Patti L. Ephraim, Courtney Cook and L. Ebony Boulware
JASN November 2014, 25 (11) 2649-2657; DOI: https://doi.org/10.1681/ASN.2013111207
Tanya S. Johns
*Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York;
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Michelle M. Estrella
†Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland;
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Deidra C. Crews
†Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland;
‡Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland;
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Lawrence J. Appel
‡Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland;
§Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
‖Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland;
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Cheryl A.M. Anderson
‡Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland;
¶Division of Preventive Medicine, Department of Family and Preventive Medicine, University of California San Diego School of Medicine, San Diego, California; and
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Patti L. Ephraim
‡Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland;
§Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
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Courtney Cook
‡Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland;
‖Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland;
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L. Ebony Boulware
‡Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland;
§Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
‖Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland;
**Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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Abstract

Young blacks receiving dialysis have an increased risk of death compared with whites in the United States. Factors influencing this disparity among the young adult dialysis population have not been well explored. Our study examined the relation of neighborhood socioeconomic status (SES) and racial differences in mortality in United States young adults receiving dialysis. We merged US Renal Data System patient-level data from 11,027 black and white patients ages 18–30 years old initiating dialysis between 2006 and 2009 with US Census data to obtain neighborhood poverty information for each patient. We defined low SES neighborhoods as those neighborhoods in US Census zip codes with ≥20% of residents living below the federal poverty level and quantified race differences in mortality risk by level of neighborhood SES. Among patients residing in low SES neighborhoods, blacks had greater mortality than whites after adjusting for baseline demographics, clinical characteristics, rurality, and access to care factors. This difference in mortality between blacks and whites was significantly attenuated in higher SES neighborhoods. In the United States, survival between young adult blacks and whites receiving dialysis differs by neighborhood SES. Additional studies are needed to identify modifiable factors contributing to the greater mortality among young adult black dialysis patients residing in low SES neighborhoods.

  • Copyright © 2014 by the American Society of Nephrology
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Journal of the American Society of Nephrology: 25 (11)
Journal of the American Society of Nephrology
Vol. 25, Issue 11
November 2014
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Neighborhood Socioeconomic Status, Race, and Mortality in Young Adult Dialysis Patients
Tanya S. Johns, Michelle M. Estrella, Deidra C. Crews, Lawrence J. Appel, Cheryl A.M. Anderson, Patti L. Ephraim, Courtney Cook, L. Ebony Boulware
JASN Nov 2014, 25 (11) 2649-2657; DOI: 10.1681/ASN.2013111207

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Neighborhood Socioeconomic Status, Race, and Mortality in Young Adult Dialysis Patients
Tanya S. Johns, Michelle M. Estrella, Deidra C. Crews, Lawrence J. Appel, Cheryl A.M. Anderson, Patti L. Ephraim, Courtney Cook, L. Ebony Boulware
JASN Nov 2014, 25 (11) 2649-2657; DOI: 10.1681/ASN.2013111207
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  • Racial Differences and Factors Associated with Pregnancy in ESKD Patients on Dialysis in the United States
  • Sociodemographic, Psychologic Health, and Lifestyle Outcomes in Young Adults on Renal Replacement Therapy
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