Low use of routine medical care among African Americans with high CKD risk: the Jackson Heart Study.
Abstract
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.
Type
Journal articlePermalink
https://hdl.handle.net/10161/17914Published Version (Please cite this version)
10.1186/s12882-018-1190-0Publication Info
Diamantidis, Clarissa J; Davenport, Clemontina A; Lunyera, Joseph; Bhavsar, Nrupen;
Scialla, Julia; Hall, Rasheeda; ... Boulware, L Ebony (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.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
Collections
More Info
Show full item recordScholars@Duke
Nrupen Bhavsar
Associate 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
L. Ebony Boulware
Nanaline Duke Distinguished Professor of Medicine
Dr. Boulware directs the Duke Clinical and Translational Science Institute as Vice
Dean for Translational Science and Associate Vice Chancellor for Translational Research,
and she is Chief of the Duke Division of General Internal Medicine in the Department
of Medicine. She is a general internist, physician-scientist and clinical epidemiologist
focused on improving health and h
Tina Davenport
Biostatistician, Senior
Dr. Davenport has extensive collaborative research experience investigating factors
that may explain racial disparities in health outcomes, primarily in kidney disease,
but also in diabetes, hypertension cardiovascular disease, and other areas. She teaches
a first-year masters level class and is passionate about teaching, mentorship, and
the importance of diversity and equity in research and healthcare.
Clarissa Jonas Diamantidis
Associate Professor of Medicine
Rasheeda Kamial Hall
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.
Joseph Lunyera
Medical Instructor in the Department of Medicine
I am a clinical epidemiologist with a life-long desire 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 exposures in the social environment perpetuate
disparate adverse kidney outcomes such as chronic kidney disease and acute kidney
injury.
Julia Jarrard Scialla
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
Crystal Cenell Tyson
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
Alphabetical list of authors with Scholars@Duke profiles.

Articles written by Duke faculty are made available through the campus open access policy. For more information see: Duke Open Access Policy
Rights for Collection: Scholarly Articles
Works are deposited here by their authors, and represent their research and opinions, not that of Duke University. Some materials and descriptions may include offensive content. More info