No abstract

Background: Geographic and neighborhood-level factors such as poverty and education have been associated with an increased risk for incident end-stage kidney disease (ESKD), likelihood of receiving pre-ESKD care, and likelihood of receiving a transplant. However, few studies have examined whether these same factors are associated with ESKD mortality. In this study, we examined county-level variation in ESKD mortality and identified county-level characteristics associated with this variation. Methods: We identified 1,515,986 individuals (aged 18-84) initiating renal replacement therapy (dialysis or transplant) between 2010 and 2018 using the United States Renal Data System. Among 2,781 counties, we estimated county-level all-cause age-standardized mortality rates (ASMR) among patients with ESKD. We then identified county-level demographic (e.g., % female), socioeconomic (e.g., % unemployed), health care (e.g., % without health insurance), and health behavior (e.g., % current smokers) characteristics associated with ASMR using multivariable hierarchical linear mixed models and quantified the percentage of ASMR variation explained by county-level characteristics. Results: County-level ESKD ASMR ranged from 45 to 1,022 per 1,000 person-years (PY) (mean, 119/1,000 PY). ASMRs were highest in counties located in the Tennessee Valley and Appalachia regions, and lowest in counties located in New England, Pacific Northwest, and southern California. In fully adjusted models, county-level characteristics significantly associated with higher ESKD mortality included a lower percentage of Black residents (-4.94/1,000 PY), lower transplant rate (-4.08/1,000 PY), and higher health care expenditures (5.21/1,000 PY). Overall, county-level characteristics explained 18.9% of variation in ESKD mortality. Conclusions: Counties with high ESKD-related mortality may benefit from targeted and multi-level interventions that combine knowledge from a growing evidence base on the interplay between individual and community-level factors associated with ESKD mortality.

Background: Hookah tobacco use is common among young adults. Unlike cigarette smoking, there is limited evidence on mobile (ie, mHealth) interventions to promote cessation. Objectives: This pilot study tested the preliminary effects of mobile messaging for cessation in young adult hookah smokers. Methods: Young adults (N = 20) aged 18 to 30 years who smoke hookah at least monthly and have done so at least once in the past 30 days received a 6-week mHealth multimedia messaging (text and images) intervention. Message scheduling (2 days/week × 6 weeks) was based on the literature. Content was developed iteratively by the study team and focused on health harms and addictiveness of hookah. Content was individually tailored by baseline hookah use frequency, risk beliefs, and responses to interactive text messages assessing participants’ hookah tobacco use behavior and beliefs to maximize impact. Engagement was assessed during the intervention, and we examined effects on risk perceptions, risk beliefs, and risk appraisals, motivation to quit, and behavior change immediately post-intervention. Results: Participants responded to 11.5 (SD = 0.69) of 12 text message prompts on average, endorsed high message receptivity (M = 6.1, SD = 0.93, range = 1-7), and reported the messages were helpful (M = 8.5, SD = 1.5, range = 1-10). There were significant ( P < .05) increases in risk perceptions (d’s = 0.22-0.88), risk appraisals (d = 0.49), risk beliefs (d = 1.11), and motivation to quit (d = 0.97) post-intervention. Half of participants reported reducing frequency of hookah use (20%) or quitting completely (30%) by end of treatment. Conclusions: These pilot results provide preliminary support for an mHealth messaging intervention about risks of hookah tobacco for promoting cessation. Rigorously examining the efficacy of this promising intervention is warranted.

BACKGROUND AND AIMS Geographic and neighborhood-level factors such as poverty and education have been associated with an increased risk for incident end-stage kidney disease (ESKD), likelihood of receiving pre-ESKD care, and likelihood of receiving a transplant. However, few studies have examined whether these same factors are associated with ESKD mortality. In this study, we examined county-level variation in ESKD mortality and identified county-level characteristics associated with this variation. METHOD We identified 1 516 507 individuals (aged 18–84) initiating renal replacement therapy (dialysis or transplant) between 2010 and 2018 using the United States Renal Data System. Among 2807 counties, we estimated county-level all-cause age-standardized mortality rates (ASMR) among patients with ESKD. We then identified county-level demographic (e.g. percentage of female), socioeconomic (e.g. percentage of unemployed), health care (e.g. percentage of without health insurance) and health behavior (e.g. percentage of current smokers) characteristics associated with ASMR using multivariable hierarchical linear mixed models and quantified the percentage of ASMR variation explained by county-level characteristics. RESULTS County-level ESKD ASMR ranged from 45 to 1022/1000 person-years (PY) (mean, 119/1000 PY). ASMRs were highest in counties located in the Tennessee Valley and Appalachia regions, and lowest in counties located in New England, Pacific Northwest and southern California (Figure 1). In fully adjusted models, county-level characteristics significantly associated with higher ESKD mortality included a lower percentage of Black residents (−5.67/1000 PY), lower median income (−5.53/1000 PY), lower number of dialysis facilities/population (−2.25/1000 PY) and higher health care expenditures (5.36/1000 PY). Overall, county-level characteristics explained 16.9% of variation in ESKD mortality. CONCLUSION Counties with high ESKD-related mortality may benefit from targeted and multi-level interventions that combine knowledge from a growing evidence base on the interplay between individual and community-level factors associated with ESKD mortality.