Geographic variation in the occurrence and outcomes of chronic kidney disease (CKD) is major area of study in epidemiology and health services and outcomes research. Geographic attributes may be as diverse as the physical, socioeconomic, and medical care characteristics of an environment. This review summarizes the recent literature pertaining to geographic risk factors and CKD.
Studies have reported on the association between CKD and physical attributes of place (ambient temperature and altitude), the impact of disasters on CKD populations, new diseases characterized by regional localization, national variations in CKD incidence and prevalence, regional variation in end-stage renal disease incidence, residential mobility and CKD risk factors, and geographic variations in CKD care. The emerging role of tools for geospatial studies – including multilevel analytical designs, which reduce the likelihood of an ecologically biased inference, and geographic information systems, which allow the simultaneous linkage, analysis, and mapping of geospatial data – is illustrated by these studies.
Our understanding of the occurrence and outcomes of CKD will continue to be expanded and deepened by the explicit study of attributes associated with place as a potential risk factor. Many of the studies reviewed are largely hypothesis generating, and a better understanding of the role of geography in the study of CKD awaits investigations that probe the mechanisms that link attributes of place to disease processes.
aDepartment of Epidemiology, Rollins School of Public Health
bDivision of Nephrology, Emory University School of Medicine, Emory University, Atlanta, Georgia, USA
Correspondence to William M. McClellan, MD, MPH, Epidemiology Department, Rollins School of Public Health, Emory University, 1518 Clifton Road N.E., Atlanta, GA 30322, USA. Tel: +1 404 727 6976; e-mail: firstname.lastname@example.org