Neighborhood environmental burden and chronic kidney disease in the US: A cross-sectional study

Abstract

Objectives

This study aims to analyze the association between overall environmental burden and chronic kidney disease prevalence in communities across the United States.

Study design

A cross-sectional study based on national neighborhood-level environmental burden and health data.

Methods

The study used data from 71,688 U S. census tracts from the Centers for Disease Control. We performed a mixed-effects linear regression model to analyze the association between the combined environmental burden and the prevalence of CKD. We analyzed whether there are differences or potential interactions in the association between environmental burden and CKD under different social vulnerability. We used the Boruta algorithm to analyze the association of different environmental indicators with the prevalence of chronic kidney disease.

Results

Neighborhoods with the highest environmental burden had a 0.377 % increase in the prevalence of CKD compared to neighborhoods with the lowest environmental burden ([95 %CI: 0.359, 0.395]; P < 0.001). This association remains significant after adjusted. The association between environmental burden and the prevalence of CKD is notably stronger in neighborhoods with the highest social vulnerability (β = 1.047 [1.028,1.065]; P < 0.001). A significant interaction (P < 0.001) between social vulnerability and environmental burdens was observed in this study. We found that air pollution was the most important variable for predicting CKD prevalence.

Conclusion

Our findings suggest that the higher cumulative environmental burden is associated with a higher prevalence of CKD in a dose-dependent manner. The strongest associations were observed in socially vulnerable neighborhoods.