Social deprivation as a key driver of spatial disparities in end-stage kidney disease incidence.

IF 4.6 2区 医学 Q1 UROLOGY & NEPHROLOGY
Clinical Kidney Journal Pub Date : 2025-08-21 eCollection Date: 2025-09-01 DOI:10.1093/ckj/sfaf266
Aghiles Hamroun, Amadou Tidiane Niang, Florent Occelli, Camille Frévent, Martin Paumelle, Clémence Béchade, Florian Bayer, Marta Blangiardo, Philippe Amouyel, Luc Dauchet, François Glowacki, Cécile Couchoud, Michaël Génin
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Abstract

Background: Despite France's universal healthcare system, significant geographic disparities in the incidence of end-stage kidney disease (ESKD) persist. We hypothesized that social deprivation is a major driver of these spatial variations, independent of healthcare access and clinical risk factors, and that its contribution is stable over time.

Methods: We conducted an ecological study including 102 226 incident ESKD cases across 34 830 municipalities in metropolitan France from 2012 to 2021, using data from the national REIN (Renal Epidemiology and Information Network) registry. A Bayesian hierarchical spatiotemporal model was used to estimate the association between ESKD incidence and ecological-level covariates: social deprivation [measured by the French European Deprivation Index (EDI)], diabetes prevalence, dialysis center accessibility and long-term exposure to PM2.5 (fine particulate matter, ≤2.5 µm in diameter). We estimated the population-attributable fraction of ESKD incidence for each factor under various counterfactual scenarios.

Results: Social deprivation was strongly associated with ESKD incidence [relative risk per 1 standard deviation increase in EDI: 1.10 (95% credible interval 1.09-1.11)] and explained 34.7% of its spatial variability. The association was only partially mediated by diabetes prevalence [mediation proportion: 15.3% (95% confidence interval 12.5-18.2)]. The model incorporating all covariates explained 49.9% of the observed spatial heterogeneity. The effect of social deprivation remained consistent over time. Reducing deprivation in the most disadvantaged areas to the levels of the 5th, 25th and 50th percentiles of less deprived areas could have prevented an estimated 23 092, 17 450 and 13 601 ESKD cases, respectively, over the study period.

Conclusions: Social deprivation is the leading ecological determinant of spatial disparities in ESKD incidence in France, with limited mediation by clinical factors and persistent effects despite universal healthcare. These findings underscore the need to address social determinants of health and to adapt kidney care delivery models to better reach socioeconomically disadvantaged populations.

社会剥夺是终末期肾病发病率空间差异的关键驱动因素。
背景:尽管法国拥有全民医疗保健系统,但终末期肾病(ESKD)发病率的显著地理差异仍然存在。我们假设社会剥夺是这些空间变化的主要驱动因素,独立于医疗保健获取和临床风险因素,并且其贡献随时间而稳定。方法:我们进行了一项生态研究,包括2012年至2021年法国大都市34 830个城市的102 226例ESKD病例,使用来自国家肾流行病学和信息网络(REIN)登记处的数据。使用贝叶斯分层时空模型来估计ESKD发病率与生态水平的共变量之间的关联:社会剥夺[由法国欧洲剥夺指数(EDI)测量],糖尿病患病率,透析中心可达性和长期暴露于PM2.5(细颗粒物,直径≤2.5µm)。我们估计了在不同的反事实情景下,每个因素的ESKD发病率的人群归因比例。结果:社会剥夺与ESKD发病率密切相关[EDI每增加1个标准差的相对风险:1.10(95%可信区间1.09-1.11)],并解释了34.7%的空间变异性。糖尿病患病率仅部分介导了这种关联[中介比例:15.3%(95%可信区间12.5-18.2)]。纳入所有协变量的模型解释了49.9%的观测到的空间异质性。社会剥夺的影响随着时间的推移而保持一致。在研究期间,如果将最贫困地区的贫困程度降低到较贫困地区的第5、第25和第50百分位数的水平,估计可以分别预防23 092、17 450和13 601例ESKD病例。结论:社会剥夺是法国ESKD发病率空间差异的主要生态决定因素,临床因素的中介作用有限,尽管全民医疗保健,其影响仍持续存在。这些发现强调需要解决健康的社会决定因素,并调整肾脏护理提供模式,以更好地覆盖社会经济弱势群体。
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来源期刊
Clinical Kidney Journal
Clinical Kidney Journal Medicine-Transplantation
CiteScore
6.70
自引率
10.90%
发文量
242
审稿时长
8 weeks
期刊介绍: About the Journal Clinical Kidney Journal: Clinical and Translational Nephrology (ckj), an official journal of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association), is a fully open access, online only journal publishing bimonthly. The journal is an essential educational and training resource integrating clinical, translational and educational research into clinical practice. ckj aims to contribute to a translational research culture among nephrologists and kidney pathologists that helps close the gap between basic researchers and practicing clinicians and promote sorely needed innovation in the Nephrology field. All research articles in this journal have undergone peer review.
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