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Low use of routine medical care among African Americans with high CKD risk: the Jackson Heart Study.

dc.contributor.author Diamantidis, Clarissa
dc.contributor.author Scialla, Julia
dc.contributor.author Hall, Rasheeda
dc.contributor.author Boulware, Ebony
dc.contributor.author Lunyera, Joseph
dc.contributor.author Bhavsar, Nrupen
dc.contributor.author Tyson, Crystal
dc.contributor.author Davenport, Clemontina A
dc.contributor.author Sims, Mario
dc.contributor.author Strigo, Tara
dc.contributor.author Powe, Neil R
dc.date.accessioned 2019-01-21T22:03:19Z
dc.date.available 2019-01-21T22:03:19Z
dc.date.issued 2019-01-10
dc.identifier 10.1186/s12882-018-1190-0
dc.identifier.issn 1471-2369
dc.identifier.issn 1471-2369
dc.identifier.uri https://hdl.handle.net/10161/17914
dc.description.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.
dc.language eng
dc.publisher Springer Nature
dc.relation.ispartof BMC nephrology
dc.relation.isversionof 10.1186/s12882-018-1190-0
dc.subject Chronic kidney disease
dc.subject Routine care
dc.subject Trust
dc.title Low use of routine medical care among African Americans with high CKD risk: the Jackson Heart Study.
dc.type Journal article
dc.date.updated 2019-01-21T22:03:18Z
pubs.begin-page 11
pubs.issue 1
pubs.organisational-group School of Medicine
pubs.organisational-group Duke
pubs.organisational-group Population Health Sciences
pubs.organisational-group Basic Science Departments
pubs.organisational-group Medicine, General Internal Medicine
pubs.organisational-group Medicine
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke Clinical Research Institute
pubs.organisational-group Institutes and Centers
pubs.organisational-group Medicine, Nephrology
pubs.organisational-group Community and Family Medicine
pubs.organisational-group Staff
pubs.organisational-group Duke Science & Society
pubs.organisational-group Initiatives
pubs.organisational-group Institutes and Provost's Academic Units
pubs.organisational-group Psychiatry & Behavioral Sciences, Behavioral Medicine
pubs.organisational-group Psychiatry & Behavioral Sciences
pubs.publication-status Published
pubs.volume 20
duke.contributor.orcid Lunyera, Joseph|0000-0002-9350-320X


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