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PLoS One. 2018 Jul 31;13(7):e0200612. doi: 10.1371/journal.pone.0200612. eCollection 2018.

County-level air quality and the prevalence of diagnosed chronic kidney disease in the US Medicare population.

Author information

1
Department of Internal Medicine-Nephrology, University of Michigan, Ann Arbor, MI, United States of America.
2
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States of America.
3
Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, United States of America.
4
Department of Urology, Medical School, University of Michigan, Ann Arbor, MI, United States of America.
5
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America.
6
Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
7
Department of Medicine University of California, San Francisco, CA, United States of America.
8
Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, San Francisco, CA, United States of America.

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 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.

PMID:
30063741
PMCID:
PMC6067706
DOI:
10.1371/journal.pone.0200612
[Indexed for MEDLINE]
Free PMC Article

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