Racial and socioeconomic differences in chronic kidney disease (CKD) were exacerbated by health-impeding social determinants of health, such as limited access to care. The Military Health System (MHS) provided an opportunity to screen a large, heterogeneous population for CKD discrepancies in universal health care. The study was conducted in a cross-sectional manner. MHS beneficiaries aged 18 to 64 years old received care between October 1, 2015, and September 30, 2018. Race, sponsor status (a proxy for socioeconomic status and social class), median household income by sponsor zip code, and marital status are all predictive factors. CKD prevalence as measured by the International Classification of Diseases, Tenth Revision codes, and a validated, laboratory value-based computerized phenotype. Multivariable logistic regression was used to assess CKD prevalence by predictors while adjusting for confounders (age, sex, active-duty status, sponsor’s service branch, and depression) and mediators (hypertension, diabetes, HIV, and body mass index). Furthermore, 105,504 (3.2%) of the 3,330,893 recipients had CKD. CKD prevalence was greater in Black than White beneficiaries (OR, 1.67; 95% CI, 1.64-1.70) in confounder-adjusted models but lower in single versus married beneficiaries (OR, 0.77; 95% CI, 0.76-0.79). In a dose-response fashion, CKD prevalence was increased among those with a lower military rank and a lower median household income (P<0.0001). When associations were further adjusted for putative mediators, they were weakened. Causal inferences were not possible due to the cross-sectional design. Due to a lack of data for laboratory tests performed outside of the MHS and the use of a specific CKD definition, researchers might have underestimated the prevalence of CKD. Because of the transient nature of the MHS population, median household income data at the zip code level may be inaccurate. Despite universal health care coverage, racial and socioeconomic CKD inequities exist in the MHS. Despite universal health care coverage, CKD differences by rank and median household income implied that societal hazards might contribute to racial and socioeconomic inequities.

 

Source –www.sciencedirect.com/science/article/pii/S2590059521002247