Low use of routine medical care among African Americans with high CKD risk: the Jackson Heart Study.
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BACKGROUND:Use of routine medical care (RMC) is advocated to address ethnic/racial disparities in chronic kidney disease (CKD) risks, but use is less frequent among African Americans. Factors associated with low RMC use among African Americans at risk of renal outcomes have not been well studied. METHODS:We examined sociodemographic, comorbidity, healthcare access, and psychosocial (discrimination, anger, stress, trust) factors associated with low RMC use in a cross-sectional study. Low RMC use was defined as lack of a physical exam within one year among participants with CKD (estimated glomerular filtration rate < 60 mL/min/1.73m2 or urine albumin-to-creatinine ratio > 30 mg/g) or CKD risk factors (diabetes or hypertension). We used multivariable logistic regression to estimate the odds of low RMC use at baseline (2000-2004) for several risk factors. RESULTS:Among 3191 participants with CKD, diabetes, or hypertension, 2024 (63.4%) were ≥ 55 years of age, and 700 (21.9%) reported low RMC use. After multivariable adjustment, age < 55 years (OR 1.61 95% CI 1.31-1.98), male sex (OR 1.71; 1.41-2.07), <high school diploma (OR 1.31; 1.07-1.62), absence of hypertension (OR 1.74; 1.27-2.39) or diabetes (OR 1.34; 1.09-1.65), and tobacco use (OR 1.43; 1.18-1.72) were associated with low RMC use. Low trust in providers (OR 2.16; 1.42-3.27), high stress (OR 1.41; 1.09-1.82), high daily discrimination (OR 1.30; 1.01-1.67) and low burden of lifetime discrimination (OR 1.52; 1.18-1.94), were also associated with low RMC use. CONCLUSIONS:High-risk African Americans who were younger, male, less-educated, and with low trust in providers were more likely to report low RMC use. Efforts to improve RMC use by targeting these populations could mitigate African Americans' disparities in CKD risks.
Published Version (Please cite this version)10.1186/s12882-018-1190-0
Publication InfoDiamantidis, Clarissa; Scialla, Julia; Hall, Rasheeda; Boulware, Ebony; Lunyera, Joseph; Bhavsar, Nrupen; ... Powe, Neil R (2019). Low use of routine medical care among African Americans with high CKD risk: the Jackson Heart Study. BMC nephrology, 20(1). pp. 11. 10.1186/s12882-018-1190-0. Retrieved from https://hdl.handle.net/10161/17914.
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Assistant Professor in Medicine
I am a quantitative epidemiologist with methodological expertise in the design and analysis of observational studies that leverage data from cohort studies, registries, and the electronic health record (EHR). My background, training, and research is in the measurement and characterization of biomarkers, risk factors and treatment outcomes for chronic disease using real-world datasets. My primary research interests are in the use of novel sources of data, including the EHR, to conduct chronic
Eleanor Easley Chair in the School of Medicine
Ebony Boulware, MD, MPH is a Professor of Medicine, Chief of the Division of General Internal Medicine in the Department of Medicine, Vice Dean for Translational Science and Associate Vice Chancellor for Translational Research in the School of Medicine at Duke University. She received an A.B. from Vassar College, an M.D. from Duke University, and a M.P.H. from the Johns Hopkins Bloomberg School of Public Health. Dr. Boulware attended medical school at Duke University,
Associate Professor of Medicine
Assistant Professor of Medicine
I am a board-certified nephrologist, and my academic career focus is geriatric nephrology. Older adults with kidney disease are one of the most vulnerable sub-populations of patients because of their high morbidity, mortality, and functional limitations and the complexity of our fragmented healthcare system. Research and clinical efforts to enhance the quality of care and quality of life of these patients is paramount. My research involves epidemiology and health services research methodologies.
I am an in-training physician-scientist with expertise in clinical epidemiology and health policy. My life-long desire is to advance our understanding of etiologic mechanisms of kidney disease, and to advocate for policies that promote the highest quality care for individuals with kidney disease. Specifically, I am interested in delineating mechanisms by which socio-environmental exposures might increase risk for adverse kidney outcomes such as chronic kidney disease and acute kidney injury
Adjunct Associate Professor in the Department of Medicine
Dr. Scialla is an Associate Professor of Medicine in Nephrology at Duke University and a faculty member at the Duke Clinical Research Institute. Dr. Scialla trained in Internal Medicine, Nephrology, and Clinical Epidemiology at the Johns Hopkins University School of Medicine and the Johns Hopkins Bloomberg School of Public Health. Her research focuses on chronic kidney disease (CKD) epidemiology and prevention, with an emphasis on the role of metabolic complications and nutri
Assistant Professor of Medicine
As a board-certified nephrologist and a certified clinical hypertension specialist (ASH-SCH), I take care of patients with kidney disorders and/or high blood pressure. Patients with chronic kidney disease and high blood pressure have an increased risk for developing complications of cardiovascular disease, such as heart attacks, congestive heart failure, strokes, kidney failure requiring dialysis or a kidney transplant, and a shortened lifespan. My clinical focus is to slow the progression of
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