Table 3.
Association of social determinants of health measures with AKI stratified by stage in hospitalized patients (no AKI [n=19,793] versus AKI stage 1 [n=6465] and no AKI [n=19,793] versus AKI stage 2/3 [n=511])
| Neighborhood Social Determinants of Health Measures | Model 1, OR (95% CI) | Model 2, OR (95% CI) | Model 3, OR (95% CI) |
|---|---|---|---|
| Area deprivation (ADI 1–10 state scale, in tertiles) | |||
| AKI stage 1 versus no AKI | |||
| Low (1–3) | Reference | Reference | Reference |
| Medium (4–6) | 1.08 (1.00 to 1.16)a | 1.08 (1.00 to 1.16)a | 1.05 (0.98 to 1.14) |
| High (7–10) | 1.22 (1.13 to 1.31)a | 1.23 (1.14 to 1.32)a | 1.11 (1.02 to 1.20)a |
| AKI stage 2/3 versus no AKI | |||
| Low (1–3) | Reference | Reference | Reference |
| Medium (4–6) | 1.17 (0.93 to 1.47) | 1.08 (0.86 to 1.37) | 1.07 (0.85 to 1.36) |
| High (7–10) | 1.17 (0.93 to 1.48) | 1.03 (0.82 to 1.31) | 1.00 (0.78 to 1.28) |
| Food desert (LILA at 1 mile for urban, 10 miles for rural areas) | |||
| AKI stage 1 versus no AKI | 1.14 (1.07 to 1.22)a | 1.14 (1.07 to 1.22)a | 1.03 (0.96 to 1.11) |
| AKI stage 2/3 versus no AKI | 1.01 (0.82 to 1.25) | 0.97 (0.78 to 1.20) | 0.93 (0.74 to 1.17) |
| Rural (RUCA 4–10) | |||
| AKI stage 1 versus no AKI | 0.96 (0.89 to 1.04) | 0.94 (0.87 to 1.01) | 1.00 (0.92 to 1.08) |
| AKI stage 2/3 versus no AKI | 1.00 (0.79 to 1.26) | 0.95 (0.75 to 1.22) | 0.97 (0.75 to 1.25) |
| Measures of segregation | |||
| Dissimilarity index (highest tertile reflects the highest vulnerability tertile) | |||
| AKI stage 1 versus no AKI | |||
| Low (0.005–0.52) | Reference | Reference | Reference |
| Medium (0.52–0.69) | 1.03 (0.96 to 1.10) | 0.99 (0.92 to 1.07) | 0.97 (0.91 to 1.05) |
| High (0.69–1) | 0.98 (0.92 to 1.05) | 0.95 (0.88 to 1.02) | 0.98 (0.91 to 1.05) |
| AKI stage 2/3 versus no AKI | |||
| Low (0.005–0.52) | Reference | Reference | Reference |
| Medium (0.52–0.69) | 0.90 (0.73 to 1.12) | 0.84 (0.67 to 1.05) | 0.84 (0.67 to 1.04) |
| High (0.69–1) | 0.95 (0.77 to 1.18) | 0.94 (0.76 to 1.16) | 0.95 (0.76 to 1.18) |
| Isolation index (highest tertile reflects the highest vulnerability tertile) | |||
| AKI stage 1 versus no AKI | |||
| Low (0.01–0.32) | Reference | Reference | Reference |
| Medium (0.32–0.70) | 1.06 (0.99 to 1.14) | 1.06 (0.99 to 1.14) | 1.02 (0.95 to 1.10) |
| High (0.70–1) | 1.19 (1.11 to 1.27)a | 1.19 (1.11 to 1.28)a | 0.98 (0.90 to 1.07) |
| AKI stage 2/3 versus no AKI | |||
| Low (0.01–0.32) | Reference | Reference | Reference |
| Medium (0.32–0.70) | 1.15 (0.92 to 1.42) | 1.11 (0.89 to 1.38) | 1.09 (0.87 to 1.36) |
| High (0.70–1) | 1.16 (0.93 to 1.45) | 1.06 (0.85 to 1.33) | 0.99 (0.76 to 1.30) |
Model 1: unadjusted, model 2: adjusted for age, sex, baseline eGFR, systolic BP, and Elixhauser Comorbidity Index, model 3: model 2 additionally adjusted for race. We assessed interactions by race, sex, and obesity with each of social determinants of health measure, and none were statistically significant. ADI, Area Deprivation Index; CI, confidence interval; LILA, Low-Income, Low-Access; OR, odds ratio; RUCA, Rural–Urban Commuting Area.
a
P < 0.05.