a Deprivation Index) had a 10% greater odds of developing AKI than counterparts in the lowest Area Deprivation Index tertile. Patients who lived in rural areas had 25% greater odds of not recovering from AKI by hospital discharge.This study demonstrates an association between neighborhood disadvantage and rurality on the development of AKI and lack of recovery from AKI. Further work is needed to understand the mechanisms of these associations and to develop community-level interventions to mitigate the health care burden of AKI for disadvantaged populations. Background AKI is common among hospitalized patients. However, the contribution of social determinants of health (SDOH) to AKI risk remains unclear. This study evaluated the association between neighborhood measures of SDOH and AKI development and recovery during hospitalization. Methods This is a retrospective cohort study of adults without ESKD admitted to a large Southern US health care system from October 2014 to September 2017. Neighborhood SDOH measures included (1) socioeconomic status: Area Deprivation Index (ADI) scores, (2) food access: Low-Income, Low-Access scores, (3) rurality: Rural–Urban Commuting Area scores, and (4) residential segregation: dissimilarity and isolation scores. The primary study outcome was AKI on the basis of serum creatinine Kidney Disease Improving Global Outcomes criteria. Our secondary outcome was lack of AKI recovery (requiring dialysis or elevated serum creatinine at discharge). The association of SDOH measures with AKI was evaluated using generalized estimating equation models adjusted for demographics and clinical characteristics. Results Among 26,769 patients, 26% developed AKI during hospitalization. Compared with those who did not develop AKI, those who developed AKI were older (median 60 versus 57 years), more commonly men (55% versus 50%), and more commonly self-identified as Black (38% versus 33%). Patients residing in most disadvantaged neighborhoods (highest ADI tertile) had 10% (95% confidence interval, 1.02 to 1.19) greater adjusted odds of developing AKI during hospitalization than counterparts in least disadvantaged areas (lowest ADI tertile). Patients living in rural areas had 25% higher adjusted odds of lack of AKI recovery by hospital discharge (95% confidence interval, 1.07 to 1.46). Food access and residential segregation were not associated with AKI development or recovery. Conclusions Hospitalized patients from the most socioeconomically disadvantaged neighborhoods and from rural areas had higher odds of developing AKI and not recovering from AKI by hospital discharge, respectively. A better understanding of the mechanisms underlying these associations is needed to inform interventions to reduce AKI risk during hospitalization among disadvantaged populations....

中文翻译：

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邻里健康社会决定因素与住院期间急性肾损伤的关联


a 剥夺指数）患 AKI 的几率比面积剥夺指数最低的三分位数的同龄人高 10%。居住在农村地区的患者出院时无法从 AKI 中恢复的几率要高出 25%。这项研究表明，社区劣势和农村性对 AKI 的发展和缺乏从 AKI 中恢复之间存在关联。需要进一步的工作来了解这些关联的机制，并制定社区层面的干预措施，以减轻 AKI 对弱势群体的医疗保健负担。背景 AKI 在住院患者中很常见。然而，健康的社会决定因素 （SDOH） 对 AKI 风险的贡献仍不清楚。本研究评估了 SDOH 的邻里测量与 AKI 发展和住院期间恢复之间的关联。方法 这是一项回顾性队列研究，对象为 2014 年 10 月至 2017 年 9 月在美国南部一个大型医疗保健系统收治的无 ESKD 成人。社区 SDOH 措施包括 （1） 社会经济地位：地区剥夺指数 （ADI） 评分，（2） 食物获取：低收入、低获取评分，（3） 农村性：农村-城市通勤区评分，以及 （4） 住宅隔离：差异性和孤立性评分。主要研究结局是基于血清肌酐肾病改善全球结局标准的 AKI。我们的次要结局是 AKI 恢复不足（需要透析或出院时血清肌酐升高）。使用针对人口统计学和临床特征进行调整的广义估计方程模型评估 SDOH 指标与 AKI 的关联。结果 在 26,769 例患者中，26% 的患者在住院期间发生 AKI。 与未发生 AKI 的患者相比，发生 AKI 的患者年龄较大（中位年龄为 60 岁 vs 57 岁），男性更常见（55% 对 50%），更常见的是自我认定为黑人（38% 对 33%）。居住在最弱势社区（最高 ADI 三分位数）的患者在住院期间发生 AKI 的调整几率比最不弱地区（最低 ADI 三分位数）高 10%（95% 置信区间，1.02 至 1.19）。居住在农村地区的患者出院时 AKI 未恢复的调整几率高出 25% （95% 置信区间，1.07 至 1.46）。食物获取和住宅隔离与 AKI 的发展或恢复无关。结论 来自社会经济最弱势社区和农村地区的住院患者发生 AKI 的几率和出院时无法从 AKI 中恢复的几率更高。需要更好地了解这些关联的潜在机制，以便为降低弱势群体住院期间 AKI 风险的干预措施提供信息。