Background: The risk of end stage renal disease (ESRD) is increased among individuals with low income and in\nlow income communities. However, few studies have examined the relation of both individual and community\nsocioeconomic status (SES) with incident ESRD.\nMethods: Among 23,314 U.S. adults in the population-based Reasons for Geographic and Racial Differences in\nStroke study, we assessed participant differences across geospatially-linked categories of county poverty [outlier\npoverty, extremely high poverty, very high poverty, high poverty, neither (reference), high affluence and outlier\naffluence]. Multivariable Cox proportional hazards models were used to examine associations of annual household\nincome and geospatially-linked county poverty measures with incident ESRD, while accounting for death as a\ncompeting event using the Fine and Gray method.\nResults: There were 158 ESRD cases during follow-up. Incident ESRD rates were 178.8 per 100,000 person-years (105 py)\nin high poverty outlier counties and were 76.3 /105 py in affluent outlier counties, p trend = 0.06. In unadjusted\ncompeting risk models, persons residing in high poverty outlier counties had higher incidence of ESRD (which was\nnot statistically significant) when compared to those persons residing in counties with neither high poverty nor\naffluence [hazard ratio (HR) 1.54, 95% Confidence Interval (CI) 0.75-3.20]. This association was markedly attenuated\nfollowing adjustment for socio-demographic factors (age, sex, race, education, and income); HR 0.96, 95% CI 0.46-\n2.00. However, in the same adjusted model, income was independently associated with risk of ESRD [HR 3.75, 95%\nCI 1.62-8.64, comparing the < $20,000 income group to the > $75,000 group]. There were no statistically significant\nassociations of county measures of poverty with incident ESRD, and no evidence of effect modification.\nConclusions: In contrast to annual family income, geospatially-linked measures of county poverty have little relation\nwith risk of ESRD. Efforts to mitigate socioeconomic disparities in kidney disease may be best appropriated at the\nindividual level.
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