Social Determinants of Health and Chronic Kidney Disease

Predictive Value of Social Determinants of Health on 90-Day Readmission and Health Utilization Following ACDF: A Comparative Analysis of XGBoost, Random Forest, Elastic-Net, SVR, and Deep Learning

Study DesignRetrospective cohort.ObjectiveDespite numerous studies highlighting patient comorbidities and surgical factors in postoperative success, the role of social determinants of health (SDH) in anterior cervical discectomy and fusion (ACDF) outcomes remains unexplored. This study evaluates the predictive impact of SDH on 90-day readmission and health utilization (HU) in ACDF patients using machine learning (ML).MethodsWe analyzed 3127 ACDF patients (2003-2023) from a multisite academic center, incorporating over 35 clinical and demographic variables. SDH characteristics were assessed using the Social Vulnerability Index. Primary outcomes included 90-day readmission and postoperative HU. ML models were developed and validated by the area under the curve (AUC) for readmission and mean absolute error (MAE) for HU. Feature importance analysis identified key predictors.ResultsBalanced Random Forest (AUC = 0.75) best predicted 90-day readmission, with length of stay, Elixhauser score, and Medicare status as top predictors. Among SDH factors, minority status & language, household composition & disability, socioeconomic status, and housing type & transportation were influential. Support Vector Regression (MAE = 1.96) best predicted HU, with perioperative duration, socioeconomic status, and minority status & language as key predictors.ConclusionsFindings highlight SDH's role in ACDF outcomes, suggesting the value of stratifying for interventions such as targeted resource allocation, language-concordant care, and tailored follow-up. While reliance on a single healthcare system and proxy SDH measures are limitations, this is the first study to apply ML to assess SDH in ACDF patients. Further validation with direct patient-reported SDH data is needed to refine predictive models.

Design and psychometric validation of a social capital questionnaire for adults with end-stage chronic kidney disease undergoing dialysis or hemodialysis

BACKGROUND

The effects of end-stage kidney disease (ESKD) can spill over into a patient's social life. Social capital (SC) is a determinant of health that can enhance patients' health through support and resources. However, no questionnaire is currently available to measure SC in ESKD patients. This study aimed to design and validate a questionnaire to measure SC in ESKD adults undergoing dialysis or hemodialysis.

METHODS

A mixed methods approach was used to generate the questionnaire and determine its content validity with a panel of nine experts and content validity index, face validity through cognitive interviews with patients, construct validity (exploratory and confirmatory factor analysis), criterion validity, reliability and the effect of known groups differences.

RESULTS

Content validity was confirmed by an expert panel, achieving a content validity index value > 0.85 for all items. Face validity was achieved through cognitive interviews with 20 patients over 18 years of age in a terminal stage of CKD, ensuring that the target population understood the questions. An exploratory factor analysis used the sample of 610 patients and tested the structure of the seven dimensions of the structural domain (participation in organizations, links to institutions, social network sizes, collective activities, diversity, bridging, and bonding) and explained 95.7% of the total variance with a reliability of 0.89, and criterion validity > 0.32 (p < 0.05) for the correlations between the indices of each dimension and the domain index. The structure of the cognitive domain was tested for six dimensions (norms of reciprocity, social harmony, feeling of belonging, perceived fairness, social support, and social trust) with a total variance of 80.7%, reliability of 0.94 and criterion validity for correlations > 0.68 (p < 0.05). The confirmatory factor analysis with 352 patients proved the factorial structure adequate for both questionnaire domains and all dimensions, with CFI and TLI values > 0.9, an RMSEA ≤ 0.06, and SRMR ≤ 0.05.

CONCLUSIONS

We conclude that the questionnaire designed to measure social capital is valid and reliable for ESKD patients in Mexico.

Long term outcomes of patients with chronic kidney disease after COVID-19 in an urban population in the Bronx

We investigated the long-term kidney and cardiovascular outcomes of patients with chronic kidney disease (CKD) after COVID-19. Our retrospective cohort consisted of 834 CKD patients with COVID-19 and 6,167 CKD patients without COVID-19 between 3/11/2020 to 7/1/2023. Multivariate competing risk regression models were used to estimate risk (as adjusted hazard ratios (aHR) with 95% confidence intervals (CI)) of CKD progression to a more advanced stage (Stage 4 or 5) and major adverse kidney events (MAKE), and risk of major adverse cardiovascular events (MACE) at 6-, 12-, and 24-month follow up. Hospitalized COVID-19 patients at 12 and 24 months (aHR 1.62 95% CI[1.24,2.13] and 1.76 [1.30, 2.40], respectively), but not non-hospitalized COVID-19 patients, were at higher risk of CKD progression compared to those without COVID-19. Both hospitalized and non-hospitalized COVID-19 patients were at higher risk of MAKE at 6-, 12- and 24-months compared to those without COVID-19. Hospitalized COVID-19 patients at 6-, 12- and 24-months (aHR 1.73 [1.21, 2.50], 1.77 [1.34, 2.33], and 1.31 [1.05, 1.64], respectively), but not non-hospitalized COVID-19 patients, were at higher risk of MACE compared to those without COVID-19. COVID-19 increases the risk of long-term CKD progression and cardiovascular events in patients with CKD. These findings highlight the need for close follow up care and therapies that slow CKD progression in this high-risk subgroup.

Health disparities in the risk of severe acidosis: real-world evidence from the All of Us cohort

OBJECTIVE

To assess the health disparities across social determinants of health (SDoH) domains for the risk of severe acidosis independent of demographical and clinical factors.

MATERIALS AND METHODS

A retrospective case-control study (n = 13 310, 1:4 matching) is performed using electronic health records (EHRs), SDoH surveys, and genomics data from the All of Us participants. The propensity score matching controls confounding effects due to EHR data availability. Conditional logistic regressions are used to estimate odds ratios describing associations between SDoHs and the risk of acidosis events, adjusted for demographic features, and clinical conditions.

RESULTS

Those with employer-provided insurance and those with Medicaid plans show dramatically different risks [adjusted odds ratio (AOR): 0.761 vs 1.41]. Low-income groups demonstrate higher risk (household income less than $25k, AOR: 1.3-1.57) than high-income groups ($100-$200k, AOR: 0.597-0.867). Other high-risk factors include impaired mobility (AOR: 1.32), unemployment (AOR: 1.32), renters (AOR: 1.41), other non-house-owners (AOR: 1.7), and house instability (AOR: 1.25). Education was negatively associated with acidosis risk.

DISCUSSION

Our work provides real-world evidence of the comprehensive health disparities due to socioeconomic and behavioral contributors in a cohort enriched in minority groups or underrepresented populations.

CONCLUSIONS

SDoHs are strongly associated with systematic health disparities in the risk of severe metabolic acidosis. Types of health insurance, household income levels, housing status and stability, employment status, educational level, and mobility disability play significant roles after being adjusted for demographic features and clinical conditions. Comprehensive solutions are needed to improve equity in healthcare and reduce the risk of severe acidosis.

Social determinants of health and quality of life in children with chronic kidney disease: insights from Saudi Arabia

BACKGROUND

Social determinants of health (SDoH) are increasingly recognized as crucial factors affecting the well-being of pediatric chronic kidney disease (CKD) patients. This study explores the impact of SDoH on the quality of life (QoL) of children with CKD in Saudi Arabia.

METHODS

This observational, descriptive, cross-sectional study included 50 participants with CKD stages three to five, as well as children with end-stage renal disease (ESRD) undergoing peritoneal dialysis (PD) or hemodialysis (HD) in Riyadh, Saudi Arabia. Data were collected from children and their caregivers using a validated Arabic-adapted version of the Pediatric Quality of Life Inventory (PedsQL) 3.0 and an SDoH survey.

RESULTS

The study revealed that access to education significantly affects pediatric QoL (H/Z score 2.825; P-value 0.005), and the lack of dietary recommendations was identified as a critical factor (H/Z score 1.441; P-value 0.029). ESRD patients on PD from larger families reported better QoL, whereas lower family income was associated with reduced QoL in PD patients (P-value 0.048). Compared to those in earlier stages of CKD, ESRD patients showed lower QoL (H/Z score 2.154; P-value 0.031).

CONCLUSION

Our study provides initial insights into the relationship between SDoH and the QoL of children with CKD in Saudi Arabia. It calls for a comprehensive approach that includes these determinants in care strategies to improve patient outcomes and QoL.

The Awareness, Prevalence, and Risk Factors of Chronic Kidney Disease Among Diabetes Mellitus and Hypertensive Patients in the Aseer Region, Saudi Arabia

Background and objective Given its ever-increasing burden, chronic kidney disease (CKD) represents a significant public health threat. CKD is characterized by a gradual alteration in the kidney's normal glomerular filtration rate, which results in the progressive loss of kidney function over a period of time ranging from a few months to years. Diabetes mellitus (DM) and hypertension (HTN) are well-known risk factors for developing CKD and end-stage renal failure. In light of this, this study aimed to assess the awareness, prevalence, and risk factors of CKD in patients with diabetes and those with HTN in the Aseer region, the Kingdom of Saudi Arabia. Methods A correlational cross-sectional study was conducted among a sample of people across Saudi Arabia. The data collection was conducted via an online questionnaire circulated on social media platforms. The study questionnaire included socioeconomic and demographic information and medical history of DM, HTN, and CKD. Also, patients' awareness of and attitude towards CKD were assessed. Results A total of 301 diabetic or hypertensive patients fulfilling the inclusion criteria completed the study questionnaire. Of them, 174 (57.8%) were aged less than 55 years, while 127 (42.2%) were aged more than 55 years; 200 (66.4%) patients were males. A total of 94 (31.2%) study patients were diabetic, 64 (21.3%) were hypertensive, and 143 (47.5%) were both diabetic and hypertensive; 226 (75.1%) study patients had an overall good awareness of CKD while only 75 (24.9%) showed a poor awareness level. Higher awareness was associated with patients' age, education, and having CKD, DM, or HTN (p<0.05). Conclusion Our findings revealed that CKD was not common among study patients, and its prevalence was found to be less than estimated based on many studies in the literature. Also, diabetic and hypertensive patients showed a higher than satisfactory level of awareness of CKD, especially young patients with high levels of education.

The Association Between Social Determinants of Health and Population Health Outcomes: Ecological Analysis

BACKGROUND

With the increased availability of data, a growing number of studies have been conducted to address the impact of social determinants of health (SDOH) factors on population health outcomes. However, such an impact is either examined at the county level or the state level in the United States. The results of analysis at lower administrative levels would be useful for local policy makers to make informed health policy decisions.

OBJECTIVE

This study aimed to investigate the ecological association between SDOH factors and population health outcomes at the census tract level and the city level. The findings of this study can be applied to support local policy makers in efforts to improve population health, enhance the quality of care, and reduce health inequity.

METHODS

This ecological analysis was conducted based on 29,126 census tracts in 499 cities across all 50 states in the United States. These cities were grouped into 5 categories based on their population density and political affiliation. Feature selection was applied to reduce the number of SDOH variables from 148 to 9. A linear mixed-effects model was then applied to account for the fixed effect and random effects of SDOH variables at both the census tract level and the city level.

RESULTS

The finding reveals that all 9 selected SDOH variables had a statistically significant impact on population health outcomes for ≥2 city groups classified by population density and political affiliation; however, the magnitude of the impact varied among the different groups. The results also show that 4 SDOH risk factors, namely, asthma, kidney disease, smoking, and food stamps, significantly affect population health outcomes in all groups (P<.01 or P<.001). The group differences in health outcomes for the 4 factors were further assessed using a predictive margin analysis.

CONCLUSIONS

The analysis reveals that population density and political affiliation are effective delineations for separating how the SDOH affects health outcomes. In addition, different SDOH risk factors have varied effects on health outcomes among different city groups but similar effects within city groups. Our study has 2 policy implications. First, cities in different groups should prioritize different resources for SDOH risk mitigation to maximize health outcomes. Second, cities in the same group can share knowledge and enable more effective SDOH-enabled policy transfers for population health.

Long COVID in the context of social determinants of health

The COVID-19 pandemic has been a challenge for the public health system and has highlighted health disparities. COVID-19 vaccines have effectively protected against infection and severe disease, but some patients continue to suffer from symptoms after their condition is resolved. These post-acute sequelae, or long COVID, continues to disproportionately affect some patients based on their social determinants of health (SDOH). This paper uses the World Health Organization's (WHO) SDOH conceptual framework to explore how SDOH influences long COVID outcomes.

Culinary Medicine Training in Core Medical School Curriculum Improved Medical Student Nutrition Knowledge and Confidence in Providing Nutrition Counseling

Background: Elective culinary medicine education has become popular to help fill important gaps in physician nutrition training. The implementation and outcomes among the inaugural cohort of medical students who received culinary medicine training as a required component of medical school curriculum at the University of Maryland School of Medicine are described. Methods: Following a series of elective pilot sessions, culinary medicine training was provided to all first-year medical students in the 2019-2020 academic year. The 3-hour training included evidence-based nutrition lecture, cooking simple recipes, and group discussion of the application to personal and patient care. Pre-/postsession questionnaires assessed nutrition knowledge, skills, and attitudes as well as nutritional counseling confidence. Paired t-tests estimated mean differences in outcomes pre- and posttraining. Qualitative data were subjected to thematic analysis. Results: Overall, 119 of 125 (95.2%) students provided pre- and posttraining outcomes data. All nutritional and patient counseling outcomes improved (P < .05). Themes of being better prepared to address healthy eating barriers in patient care and personal ability to make healthy dietary changes were noted in qualitative analysis. Conclusion: One session of culinary medicine training in core medical student curriculum was feasible and improved medical student nutrition knowledge, skills, and attitudes and confidence in patient nutrition counseling.

Social, political and legal determinants of kidney health: Perspectives from lower- and middle-income countries with a focus on India

The social determinants of health (SDoH) are the non-medical factors that influence kidney health outcomes directly or indirectly in a substantial manner and include conditions in which people are born, grow, work, live, and age. Many such challenges in lower- and middle- income countries have an unfavourable impact on kidney health. These conditions potentially influence economic policies and systems, development agendas, social norms, social policies, and political systems. In addition, many political and legal factors also determine and modify the ultimate outcome in patients with kidney disease. Legal factors that ensure universal health care, promote gender and racial equality, prevent malpractices and regulate strict laws in the field of kidney transplantation are the paramount determinants for the provision of necessary kidney care. Converging lines of evidence have supported the impact of social variables such as socioeconomic resources, social inclusion, housing conditions, educational attainment, and financial status on kidney health, particularly affect vulnerable and disadvantaged groups and result in challenges in kidney care delivery. Furthermore, the climate is an important SDoH that plays a crucial role in the occurrence, prevalence, and progression of kidney diseases as highlighted by the presence of higher prevalence of chronic kidney disease in hot tropical countries. The rising incidence of water and vector-borne diseases causing acute kidney injury is another consequence of disruptive environmental and climate change which is detrimental to kidney health. Political risk factors such as conflict also have a devastating influence on kidney health. The relationship between SDoH and kidney health outcomes requires more clarity. Gaps in the current knowledge need to be identified to inform the development of appropriate interventions to address upstream socio-economic risk factors for kidney disease.

Interprofessional Culinary Medicine Training Enhanced Nutrition Knowledge, Nutrition Counseling Confidence, and Interprofessional Experience

Introduction: Culinary medicine training combining evidence-based nutrition instruction with experiential cooking application has improved nutrition knowledge, skills, and attitudes in the professional and personal lives of medical students. However, interprofessional culinary training remains largely unstudied among professional students who will be involved in collaborative patient care. The goal of this study was to evaluate the feasibility and effectiveness of an elective interprofessional culinary medicine course for students in the medical, pharmacy, social work, nursing, law, and dentistry schools at the University of Maryland, Baltimore. Methods: The interprofessional culinary medicine course was offered in-person at the teaching kitchen of the Nova Institute for Health in 2020 and virtually in 2021 during the COVID pandemic. The training featured five workshops combining instruction in a variety of popular diets, cooking a meal inspired by the diet in focus, and group discussion. Paired t tests were utilized to evaluate changes in pre-/post-training nutrition and interprofessional experience outcomes. Linear regression models were constructed to compare outcomes between in-person and virtual delivery. Results: A total of 62 students participated in the culinary medicine training. Confidence in all nutrition knowledge, skills, and attitudes, as well as interprofessional experience outcomes, improved after the training (p < 0.05). Similar improvements were noted in most outcomes with in-person and virtual delivery in linear regression modeling. Discussion: Interprofessional culinary medicine training is feasible, and virtual delivery may help enhance replicability in other settings.

A Spectrum of Biopsy - Proven Renal Disorders and Their Clinicopathological Correlation in Elderly Population From a Tertiary Care Center in South India

Introduction

Chronic kidney disease (CKD) has become a health concern with an extensive burden on incidence and prognosis. While the increasing lifespan contributes to a higher incidence of CKD among the elderly, the diagnostic picture in this age group is complicated by senescence-related changes. A better understanding of the etiology and progression of the disease warrants renal biopsy in such patients. This study aims to explore the histopathological spectrum of native renal biopsies leading to CKD in elderly patients in a tertiary care hospital.

Methods

Among the list of patients who had undergone renal biopsy at our institute from January 2015 to March 2020, elderly patients aged ≥ 60years were chosen for this study. Their demographic details, lab investigations and histopathological reports were collected. The sex distribution and prevalence of different renal diseases was calculated. The subjects were classified into four broad diagnostic groups - primary glomerular disease, diabetic nephropathy, hypertensive nephropathy, and tubulointerstitial disease. The estimated glomerular filtration rate (eGFR) values were calculated and used to stage chronic kidney disease in these patients. Statistical analysis was carried out to find a correlation between diagnostic groups and CKD presence and between serum C3 values and immunofluorescence for the same on biopsy.

Results

One hundred thirty-two patients formed the study sample with a male to female ratio of 1.28:1, showing a slight male predominance. The most common diagnostic group was primary glomerular disease (46%), among which focal segmental glomerulosclerosis (FSGS) was the most common entity (12%). 47.7% and 66.6% of patients in the study sample showed elevated serum blood urea nitrogen (BUN) and creatinine values, respectively. 86% of our study sample had low eGFR values, and the majority (35%) of the patients were classified under CKD stage 3. CKD incidence was high among patients with primary glomerular diseases, but no significant statistical correlation was found. 43.5% of all IF positive cases showed low serum C3 values and established a positive correlation between IF and serum C3 values.

Conclusion

There is no statistically significant correlation of the four diagnostic groups to the CKD. CKD in the elderly may be multifactorial, and a collaborative study across the nations may be needed to further evaluate the etiology.