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BMC Nephrology
Published in: BMC Nephrology 1/2019

Open Access 01-12-2019 | Care | Research article

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

Authors: Clarissa J. Diamantidis, Clemontina A. Davenport, Joseph Lunyera, Nrupen Bhavsar, Julia Scialla, Rasheeda Hall, Crystal Tyson, Mario Sims, Tara Strigo, Neil R. Powe, L. Ebony Boulware

Published in: BMC Nephrology | Issue 1/2019

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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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Metadata
Title
Low use of routine medical care among African Americans with high CKD risk: the Jackson Heart Study
Authors
Clarissa J. Diamantidis
Clemontina A. Davenport
Joseph Lunyera
Nrupen Bhavsar
Julia Scialla
Rasheeda Hall
Crystal Tyson
Mario Sims
Tara Strigo
Neil R. Powe
L. Ebony Boulware
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Nephrology / Issue 1/2019
Electronic ISSN: 1471-2369
DOI
https://doi.org/10.1186/s12882-018-1190-0

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