The Healthy People 2020 initiative aims to eliminate socioeconomic health disparities in the U.S. by the year 2020, including among patients with chronic kidney disease (CKD). Now, a recent study finds that low individual income is a stronger indicator of risk than community poverty.

“The findings of our study support a focus on individual rather than community resources when attempting to reduce disparities in ESRD [end stage renal disease], and emphasize the need to prevent and better manage established CKD risk factors such as diabetes and hypertension among low income individuals,” wrote the researchers led by Deidra C. Crews, MD, assistant professor of medicine at Johns Hopkins University School of Medicine in Baltimore. 

For the study, published in BMC Nephrology, the investigators analyzed data for 23,314 adults aged 45 and older in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. They looked at demographic factors such as race, household income and geographically concentrated county poverty. A majority of participants resided in the “stroke belt,” an area of the southeastern U.S. with a higher than usual number of strokes.

Continue Reading

During follow-up, ESRD developed in 158 individuals. ESRD incidence was 178.8 per 100,000 persons per year in counties of highest poverty and 76.3 in the most affluent counties. However, these differences were almost entirely accounted for by race and income.

Notably, the odds of ESRD were almost 4 times higher among people with an annual household income of less than $20,000 compared with those making more than $75,000. Few participants (6.7%) lacked health insurance.

The researchers cited several study limitations including the possibility that advanced kidney disease could have led to economic disadvantage.


  1. Crews, DC, et al. BMC Nephrology, 2014; doi: 10.1186/1471-2369-15-192