Mapping the Overlap of Poverty Level and Prevalence of Diagnosed Chronic Kidney Disease Among Medicare Beneficiaries in the United States

Little national evidence is available on spatial disparities in distributions of parks and green spaces in the USA. This study examines ecological associations of spatial access to parks and green spaces with percentages of black, Hispanic, and low-income residents across the urban-rural continuum in the conterminous USA. Census tract-level park and green space data were linked with data from the 2010 U.S. Census and 2006-2010 American Community Surveys. Linear mixed regression models were performed to examine these associations. Poverty levels were negatively associated with distances to parks and percentages of green spaces in urban/suburban areas while positively associated in rural areas. Percentages of blacks and Hispanics were in general negatively linked to distances to parks and green space coverage along the urban-rural spectrum. Place-based race-ethnicity and poverty are important correlates of spatial access to parks and green spaces, but the associations vary across the urbanization levels.

Low socioeconomic status (SES) influences disease incidence and contributes to poor health outcomes throughout an individual's life course across a wide range of populations. Low SES is associated with increased incidence of chronic kidney disease, progression to end-stage renal disease, inadequate dialysis treatment, reduced access to kidney transplantation, and poor health outcomes. Similarly, racial and ethnic disparities, which in the USA are strongly associated with lower SES, are independently associated with poor health outcomes. In this Review, we discuss individual-level and group-level SES factors, and the concomitant role of race and ethnicity that are associated with and mediate the development of chronic kidney disease, progression to end-stage renal disease and access to treatment.