Intraregional differences in renal function in the Northern Netherlands: The Lifelines Cohort Study
Although the interregional disparity in chronic kidney disease (CKD) prevalence has been reported globally, little is known about differences in CKD prevalence within a region. We aimed to study the intraregional distribution of renal function in the Northern Netherlands and identify determinants of...
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| description | Although the interregional disparity in chronic kidney disease (CKD) prevalence has been reported globally, little is known about differences in CKD prevalence within a region. We aimed to study the intraregional distribution of renal function in the Northern Netherlands and identify determinants of geographical differences in renal function.
We included 143,735 participants from the Lifelines population-based cohort in the Northern Netherlands. Spatial analysis was performed to identify regional clusters of lower eGFR (cold spots) and higher eGFR (hot spots) at the postal code level, without and with adjustment for clinical risk factors. Multivariate logistic regression was used to identify the contribution of neighborhood-level health-related behaviors, socioeconomic status, and environmental factors (air pollution parameters, urbanity) to regional clustering of lower eGFR.
Significant spatial clustering of renal function was found for eGFR as well as for early stage renal function impairment (eGFR |
| doi_str_mv | 10.1371/journal.pone.0223908 |
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We included 143,735 participants from the Lifelines population-based cohort in the Northern Netherlands. Spatial analysis was performed to identify regional clusters of lower eGFR (cold spots) and higher eGFR (hot spots) at the postal code level, without and with adjustment for clinical risk factors. Multivariate logistic regression was used to identify the contribution of neighborhood-level health-related behaviors, socioeconomic status, and environmental factors (air pollution parameters, urbanity) to regional clustering of lower eGFR.
Significant spatial clustering of renal function was found for eGFR as well as for early stage renal function impairment (eGFR<90 ml/min/1.73 m2), (p<0.001). Spatial clustering persisted after adjustment of eGFR for clinical risk factors. In adjusted cold spots, the aggregate eGFR was lower (mean ± SD: 96.5±4.8 vs. 98.5±4.0 ml/min/1.73 m2, p = 0.001), and the prevalence of early stage renal function impairment (35.8±10.9 vs. 28.7±9.8%, p<0.001) and CKD stages 3-5 was higher (median (interquartile range): 1.2(0.1-2.4) vs 0(0-1.4)%, p<0.001) than in hot spots. In multivariable logistic regression, exposure to NO2 (Odd ratio [OR], 1.45; 95% confidence interval [95% CI], 1.19 to 1.75, p<0.001) was associated with cold spots (lower renal function), whereas proportion of fat intake in the diet (OR, 0.68; 95%CI, 0.48-0.97, P = 0.031) and income (OR, 0.91; 95%CI, 0.86-0.96, p<0.001) for median level income) were inversely related.
Significant intraregional clustering of renal function, early renal function impairment and CKD were observed in the Northern Netherlands even after adjustment for renal function-related clinical risk factors. Environmental (air pollution), neighborhood-level socioeconomic factors and diet are determinants of intraregional renal function distribution. Spatial analysis might be a useful adjunct to guide public health strategies for the prevention of CKD.]]></description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0223908</identifier><identifier>PMID: 31613916</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Air pollution ; Biology and Life Sciences ; Cardiovascular disease ; Care and treatment ; Chronic illnesses ; Chronic kidney failure ; Cluster Analysis ; Clustering ; Cohort analysis ; Cohort Studies ; Confidence intervals ; Diet ; Ecology and Environmental Sciences ; Environmental factors ; Environmental risk ; Epidermal growth factor receptors ; Female ; Glomerular Filtration Rate ; Health aspects ; Health Behavior ; Health care ; Health risks ; Humans ; Impairment ; Income ; Kidney - physiopathology ; Kidney diseases ; Male ; Medicine and Health Sciences ; Middle Aged ; Mortality ; Multivariate Analysis ; Neighborhoods ; Nephrology ; Netherlands - epidemiology ; Nitrogen dioxide ; Outdoor air quality ; Patient outcomes ; People and places ; Pollution ; Pollution levels ; Population ; Prevalence ; Prevention ; Preventive medicine ; Public Health ; Regional analysis ; Regression analysis ; Renal function ; Renal Insufficiency, Chronic - epidemiology ; Renal Insufficiency, Chronic - physiopathology ; Risk analysis ; Risk Factors ; Social class ; Social factors ; Social Sciences ; Sociodemographics ; Socioeconomic data ; Socioeconomic factors ; Socioeconomics ; Spatial Analysis ; Statistical analysis ; Studies ; Systematic review</subject><ispartof>PloS one, 2019-10, Vol.14 (10), p.e0223908</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Cai et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 Cai et al 2019 Cai et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-93b5c449a52438e93030ac82e687f1aabacccb9fdf2b1827fddc12a2dfc9e3913</citedby><cites>FETCH-LOGICAL-c692t-93b5c449a52438e93030ac82e687f1aabacccb9fdf2b1827fddc12a2dfc9e3913</cites><orcidid>0000-0001-9875-2419 ; 0000-0003-3356-6791</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6793867/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6793867/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31613916$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cai, Qingqing</creatorcontrib><creatorcontrib>Dekker, Louise H</creatorcontrib><creatorcontrib>Bakker, Stephan J L</creatorcontrib><creatorcontrib>de Borst, Martin H</creatorcontrib><creatorcontrib>Navis, Gerjan</creatorcontrib><title>Intraregional differences in renal function in the Northern Netherlands: The Lifelines Cohort Study</title><title>PloS one</title><addtitle>PLoS One</addtitle><description><![CDATA[Although the interregional disparity in chronic kidney disease (CKD) prevalence has been reported globally, little is known about differences in CKD prevalence within a region. We aimed to study the intraregional distribution of renal function in the Northern Netherlands and identify determinants of geographical differences in renal function.
We included 143,735 participants from the Lifelines population-based cohort in the Northern Netherlands. Spatial analysis was performed to identify regional clusters of lower eGFR (cold spots) and higher eGFR (hot spots) at the postal code level, without and with adjustment for clinical risk factors. Multivariate logistic regression was used to identify the contribution of neighborhood-level health-related behaviors, socioeconomic status, and environmental factors (air pollution parameters, urbanity) to regional clustering of lower eGFR.
Significant spatial clustering of renal function was found for eGFR as well as for early stage renal function impairment (eGFR<90 ml/min/1.73 m2), (p<0.001). Spatial clustering persisted after adjustment of eGFR for clinical risk factors. In adjusted cold spots, the aggregate eGFR was lower (mean ± SD: 96.5±4.8 vs. 98.5±4.0 ml/min/1.73 m2, p = 0.001), and the prevalence of early stage renal function impairment (35.8±10.9 vs. 28.7±9.8%, p<0.001) and CKD stages 3-5 was higher (median (interquartile range): 1.2(0.1-2.4) vs 0(0-1.4)%, p<0.001) than in hot spots. In multivariable logistic regression, exposure to NO2 (Odd ratio [OR], 1.45; 95% confidence interval [95% CI], 1.19 to 1.75, p<0.001) was associated with cold spots (lower renal function), whereas proportion of fat intake in the diet (OR, 0.68; 95%CI, 0.48-0.97, P = 0.031) and income (OR, 0.91; 95%CI, 0.86-0.96, p<0.001) for median level income) were inversely related.
Significant intraregional clustering of renal function, early renal function impairment and CKD were observed in the Northern Netherlands even after adjustment for renal function-related clinical risk factors. Environmental (air pollution), neighborhood-level socioeconomic factors and diet are determinants of intraregional renal function distribution. Spatial analysis might be a useful adjunct to guide public health strategies for the prevention of CKD.]]></description><subject>Adult</subject><subject>Air pollution</subject><subject>Biology and Life Sciences</subject><subject>Cardiovascular disease</subject><subject>Care and treatment</subject><subject>Chronic illnesses</subject><subject>Chronic kidney failure</subject><subject>Cluster Analysis</subject><subject>Clustering</subject><subject>Cohort analysis</subject><subject>Cohort Studies</subject><subject>Confidence intervals</subject><subject>Diet</subject><subject>Ecology and Environmental Sciences</subject><subject>Environmental factors</subject><subject>Environmental risk</subject><subject>Epidermal growth factor receptors</subject><subject>Female</subject><subject>Glomerular Filtration Rate</subject><subject>Health aspects</subject><subject>Health Behavior</subject><subject>Health care</subject><subject>Health risks</subject><subject>Humans</subject><subject>Impairment</subject><subject>Income</subject><subject>Kidney - physiopathology</subject><subject>Kidney diseases</subject><subject>Male</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Multivariate Analysis</subject><subject>Neighborhoods</subject><subject>Nephrology</subject><subject>Netherlands - epidemiology</subject><subject>Nitrogen dioxide</subject><subject>Outdoor air quality</subject><subject>Patient outcomes</subject><subject>People and places</subject><subject>Pollution</subject><subject>Pollution levels</subject><subject>Population</subject><subject>Prevalence</subject><subject>Prevention</subject><subject>Preventive medicine</subject><subject>Public Health</subject><subject>Regional analysis</subject><subject>Regression analysis</subject><subject>Renal function</subject><subject>Renal Insufficiency, Chronic - epidemiology</subject><subject>Renal 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one</jtitle><addtitle>PLoS One</addtitle><date>2019-10-15</date><risdate>2019</risdate><volume>14</volume><issue>10</issue><spage>e0223908</spage><pages>e0223908-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract><![CDATA[Although the interregional disparity in chronic kidney disease (CKD) prevalence has been reported globally, little is known about differences in CKD prevalence within a region. We aimed to study the intraregional distribution of renal function in the Northern Netherlands and identify determinants of geographical differences in renal function.
We included 143,735 participants from the Lifelines population-based cohort in the Northern Netherlands. Spatial analysis was performed to identify regional clusters of lower eGFR (cold spots) and higher eGFR (hot spots) at the postal code level, without and with adjustment for clinical risk factors. Multivariate logistic regression was used to identify the contribution of neighborhood-level health-related behaviors, socioeconomic status, and environmental factors (air pollution parameters, urbanity) to regional clustering of lower eGFR.
Significant spatial clustering of renal function was found for eGFR as well as for early stage renal function impairment (eGFR<90 ml/min/1.73 m2), (p<0.001). Spatial clustering persisted after adjustment of eGFR for clinical risk factors. In adjusted cold spots, the aggregate eGFR was lower (mean ± SD: 96.5±4.8 vs. 98.5±4.0 ml/min/1.73 m2, p = 0.001), and the prevalence of early stage renal function impairment (35.8±10.9 vs. 28.7±9.8%, p<0.001) and CKD stages 3-5 was higher (median (interquartile range): 1.2(0.1-2.4) vs 0(0-1.4)%, p<0.001) than in hot spots. In multivariable logistic regression, exposure to NO2 (Odd ratio [OR], 1.45; 95% confidence interval [95% CI], 1.19 to 1.75, p<0.001) was associated with cold spots (lower renal function), whereas proportion of fat intake in the diet (OR, 0.68; 95%CI, 0.48-0.97, P = 0.031) and income (OR, 0.91; 95%CI, 0.86-0.96, p<0.001) for median level income) were inversely related.
Significant intraregional clustering of renal function, early renal function impairment and CKD were observed in the Northern Netherlands even after adjustment for renal function-related clinical risk factors. Environmental (air pollution), neighborhood-level socioeconomic factors and diet are determinants of intraregional renal function distribution. Spatial analysis might be a useful adjunct to guide public health strategies for the prevention of CKD.]]></abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>31613916</pmid><doi>10.1371/journal.pone.0223908</doi><tpages>e0223908</tpages><orcidid>https://orcid.org/0000-0001-9875-2419</orcidid><orcidid>https://orcid.org/0000-0003-3356-6791</orcidid><oa>free_for_read</oa></addata></record> |
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| language | eng |
| recordid | cdi_plos_journals_2305976375 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Adult Air pollution Biology and Life Sciences Cardiovascular disease Care and treatment Chronic illnesses Chronic kidney failure Cluster Analysis Clustering Cohort analysis Cohort Studies Confidence intervals Diet Ecology and Environmental Sciences Environmental factors Environmental risk Epidermal growth factor receptors Female Glomerular Filtration Rate Health aspects Health Behavior Health care Health risks Humans Impairment Income Kidney - physiopathology Kidney diseases Male Medicine and Health Sciences Middle Aged Mortality Multivariate Analysis Neighborhoods Nephrology Netherlands - epidemiology Nitrogen dioxide Outdoor air quality Patient outcomes People and places Pollution Pollution levels Population Prevalence Prevention Preventive medicine Public Health Regional analysis Regression analysis Renal function Renal Insufficiency, Chronic - epidemiology Renal Insufficiency, Chronic - physiopathology Risk analysis Risk Factors Social class Social factors Social Sciences Sociodemographics Socioeconomic data Socioeconomic factors Socioeconomics Spatial Analysis Statistical analysis Studies Systematic review |
| title | Intraregional differences in renal function in the Northern Netherlands: The Lifelines Cohort Study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-02T04%3A23%3A58IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Intraregional%20differences%20in%20renal%20function%20in%20the%20Northern%20Netherlands:%20The%20Lifelines%20Cohort%20Study&rft.jtitle=PloS%20one&rft.au=Cai,%20Qingqing&rft.date=2019-10-15&rft.volume=14&rft.issue=10&rft.spage=e0223908&rft.pages=e0223908-&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0223908&rft_dat=%3Cgale_plos_%3EA602782823%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2305976375&rft_id=info:pmid/31613916&rft_galeid=A602782823&rft_doaj_id=oai_doaj_org_article_e864b24c7f504336868c6d16f22a445c&rfr_iscdi=true |