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.

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Citation

Published Version (Please cite this version)

10.1186/s12882-018-1190-0

Publication Info

Diamantidis, Clarissa J, Clemontina A Davenport, Joseph Lunyera, Nrupen Bhavsar, Julia Scialla, Rasheeda Hall, Crystal Tyson, Mario Sims, et al. (2019). Low use of routine medical care among African Americans with high CKD risk: the Jackson Heart Study. BMC nephrology, 20(1). p. 11. 10.1186/s12882-018-1190-0 Retrieved from https://hdl.handle.net/10161/17914.

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Scholars@Duke

Diamantidis

Clarissa Jonas Diamantidis

Adjunct Associate Professor of Medicine
Davenport

Tina Davenport

Biostatistician, Senior

Clemontina A. Davenport earned a MSTAT and PhD in Statistics at NC State University. 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.

Bhavsar

Nrupen Bhavsar

Associate Professor in Surgery

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 disease research at the intersection of informatics, biostatistics, and epidemiology. My ongoing work aims to integrate informatics, epidemiology, and biostatistics to reduce the burden of chronic disease. I have topical expertise in multiple chronic diseases, including oncology, cardiovascular disease, and chronic kidney disease. In parallel, I have a portfolio of research that aims to understand the impact of social determinants of health, including dynamic neighborhood changes, such as gentrification, on the health of adults and children. 

Scialla

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 nutrition. Current studies are focused on treatment and prevention of abnormal phosphate homeostasis, acid-base physiology, diabetic and other forms of kidney disease, and outcomes in end-stage kidney disease. 

Dr. Scialla’s work engages a number of study designs including prospective cohort studies, observational comparative effectiveness studies, and patient-oriented physiologic studies. She has worked closely with multiple chronic disease cohorts including the Chronic Renal Insufficiency Cohort (CRIC) Study, the African American Study of Kidney Disease and Hypertension (AASK), the Jackson Heart Study (JHS), and secondary analyses in clinical trials. Studies in electronic health records (EHR) and registries have engaged dialysis EHR data, the United States Renal Data System, and public registries, such as the National Health and Nutrition Examination Survey. Physiologic studies include the Acid Base Complication in CKD Study, secondary analyses in the DASH Mechanism Study, and the newly launched MURDOCK Kidney Health Study.

Hall

Rasheeda Hall

Associate Professor of Medicine

I am a physician-scientist with an academic career focus is geriatric nephrology.  The aim of my work is to transform the standard of care for vulnerable adults who have both advanced kidney disease and geriatric problems. I use epidemiology and health services research methodologies to identify effective novel interventions that integrate geriatric principles into kidney care settings. I lead a geriatric nephrology clinic at the Durham VA that integrates a brief geriatric assessment with kidney disease management and dialysis decision-making.

Tyson

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 chronic kidney disease and reduce complications from cardiovascular disease with lifestyle modification. I particularly enjoy treating patients with severe or difficult to control high blood pressure by focusing on finding an effective medication regimen that provides the least side effects, eliminating ineffective medications, simplifying medication schedules, and promoting healthy lifestyle behavior. I see patients 2 days per week in the Duke Nephrology Clinic and the Duke Nephrology Hypertension Clinic.

My research interests are to reduce racial and health disparities among patients with hypertension and chronic kidney disease using lifestyle modifications. My past and current research investigates the effects of diet (i.e., the DASH diet, sodium reduction), exercise, and weight loss on blood pressure and kidney function, as well as the effect of bilateral renal artery denervation on blood pressure.

Boulware

L. Ebony Boulware

Adjunct Professor in the Department of Medicine

Dr. Boulware is a general internist, physician-scientist and clinical epidemiologist focused on improving health and health equity for individuals and communities affected by chronic health conditions such as kidney disease. A national thought leader in health equity, she has identified patient, clinician, system, and community-level barriers that result in disparate outcomes for Black and other marginalized individuals. Using pragmatic trials, she has developed successful interventions, shaped guidelines, raised physician awareness and changed clinical practice.  Throughout her work, Dr. Boulware has sought to improve transparency and trustworthiness in science and medicine. 

Her research has been continuously funded by the National Institutes for Health, the Patient Centered Outcomes Research Institute, and other organizations throughout her career. She has published over 200 manuscripts, book chapters, and editorials, and she mentors numerous students, residents, fellows, and faculty members.  Dr. Boulware is an elected member of the American Society for Clinical Investigation, the Association of American Physicians, the National Academy of Medicine, and the American Academy of Arts and Sciences.

PubMed Listing Here (Link)

Education

  • A.B. Vassar College, 1991
  • M.D. Duke University, 1995
  • M.P.H. Johns Hopkins Bloomberg School of Public Health, 1999


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