Does Overall Environmental Quality Affect End-Stage Renal Disease Survival?

摘要

Prevalence of end-stage renal disease (ESRD) in the U.S. increased by 74% from 2000 to 2013, with a 5-year survival of only 42%. To investigate associations between environmental quality and ESRD survival time, we used the Environmental Quality Index (EQI), an aggregate measure of ambient environmental quality at a county level across the U.S., composed of five domains (air, water, land, built, and sociodemographic). Associations between EQI and survival time for 1,091,742 people with ESRD (18y or older and without changes in county residence) from the US Renal Data System were evaluated using proportional-hazards models adjusting for sex, race, age at first ESRD service date, body mass index, alcohol and tobacco use post ESRD diagnosis, and rurality. The models compared the overall EQI percentiles [0-5), [5-20), [20-40), [40-60), [60-80), [80-95), and [95-100], where lower percentiles are interpreted as better EQI. Stratification of findings by age and distance from nearest hospital were examined. >50% of people lived in the two worst (i.e. highest) EQI percentiles. In the full model, there was no consistent direction of association across EQI strata. While age was a significant predictor of survival (Hazard Ratio, 4.27; 95% Confidence Interval, 4.21-4.33 for people > 65 vs. people < 40), there was no evidence of age-specific association with EQI. When considering distance from the nearest hospital, those living <10 miles had increased survival in the worst EQI strata (median survival 3.0 vs. 3.5 years for best vs. worst EQI, respectively); however, for people living >20 miles from a hospital, median survival was higher in the best (4.2) vs worst (3.4) EQI. This association held across different rural/urban categories and age groups. While studies have reported associations between EQI and many health outcomes, additional factors should be considered for modeling ESRD survival. This abstract does not reflect EPA policy.