ArticleAmerican journal of kidney diseases : the official journal of the National Kidney Foundation2013
Association between lack of health insurance and risk of death and ESRD: results from the Kidney Early Evaluation Program (KEEP).
Article in American journal of kidney diseases : the official journal of the National Kidney Foundation, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 41 papers, 1 of them a synthesis that pooled it.
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Who cites it
41 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Risk of End-Stage Renal Disease in Patients With Lupus Nephritis, 1971-2015: A Systematic Review and Bayesian Meta-Analysis.Arthritis & rheumatology (Hoboken, N.J.) · 2016Pooled it
- Social Determinants of Health and ESKD among Survivors of Critical Illness and Acute Kidney Injury.Clinical journal of the American Society of Nephrology : CJASN · 2026Observational
- Risks of Major Adverse Kidney Events in Non-Hispanic Black Patients with Diabetes or Hypertension: A Real-World Cohort Study.American journal of nephrology · 2026Article
- Social vulnerability and chronic kidney disease-associated mortality in the United States: 1999-2020.Journal of nephrology · 2025Article
- Effect of pre-end-stage kidney disease nephrology care on the association between neighborhood poverty and referral for kidney transplantation among patients with end-stage kidney disease.Journal of clinical epidemiology · 2025Article
- Balancing Efficiency and Equity in Population-Wide CKD Screening.JAMA network open · 2025Article
- Social Determinants of Health for Cardiovascular-Kidney-Metabolic Syndrome Among Patients With Diabetes.Journal of the Endocrine Society · 2024Article
- Systematic decision frameworks for the socially responsible use of precision medicine.NPJ genomic medicine · 2024Article
- Work disability and employment status among advanced chronic kidney disease patients.PloS one · 2024Article
- Deprivation and chronic kidney disease-a review of the evidence.Clinical kidney journal · 2023Review
- Social determinants of health and the transition from advanced chronic kidney disease to kidney failure.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2023Article
- Article
- Vital Signs: Health Disparities in Hemodialysis-Associated Staphylococcus aureus Bloodstream Infections - United States, 2017-2020.MMWR. Morbidity and mortality weekly report · 2023Article
- Predictors of rapid progression of estimated glomerular filtration rate among persons living with diabetes and/or hypertension in Ghana: Findings from a multicentre study.Journal of clinical hypertension (Greenwich, Conn.) · 2022Article
- Emergency department visits for hemodialysis by insurance status in the United States.Journal of the American College of Emergency Physicians open · 2022Article
- Clinical epidemiological analysis of cohort studies investigating the pathogenesis of kidney disease.Clinical and experimental nephrology · 2022Review
- Racial and Socioeconomic Disparities in CKD in the Context of Universal Health Care Provided by the Military Health System.Kidney medicine · 2022Article
- Social and Cultural Challenges in Caring for Latinx Individuals With Kidney Failure in Urban Settings.JAMA network open · 2021Article
- Patient Navigation: Addressing Social Challenges in Dialysis Patients.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2020Review
- Socioeconomic Position and Incidence of Glomerular Diseases.Clinical journal of the American Society of Nephrology : CJASN · 2020Article
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Authors and funding
8 authors.
Funding
Abstract
backgroundUninsured adults in the United States have poor access to health care services and worse health outcomes than insured adults. Little is known about the association between lack of insurance and chronic kidney disease (CKD) progression to end-stage renal disease (ESRD) or death in patients at high risk of kidney disease. We used 2000-2011 data from the National Kidney Foundation's Kidney Early Evaluation Program (KEEP) to examine this association.
methodsThe study population included KEEP participants younger than 65 years. Outcomes were time to ESRD (chronic kidney failure treated by renal replacement therapy) and time to death. Incident ESRD was ascertained by linkage to the US Renal Data System, and vital status, by linkage to the Social Security Administration Death Master File. We used Cox proportional hazard regression to examine the association between insurance and risk of death or ESRD after adjusting for demographic variables.
resultsOf 86,588 participants, 27.8% had no form of insurance, 10.3% had public insurance, and 61.9% had private insurance; 15.0% had CKD (defined as estimated glomerular filtration rate <60 mL/min/1.73 m(2) or urine albumin-creatinine ratio ≥ 30 mg/g), 63.3% had hypertension, and 27.7% had diabetes. Of participants with CKD, 29.3% had no health insurance. Participants without insurance were younger, more likely to be Hispanic and to have 12 or fewer years of education, and less likely to have seen a physician in the past year. After adjustment for demographic characteristics, uninsured KEEP participants were 82% more likely than privately insured participants to die (HR, 1.82; 95% CI, 1.56-2.12; P < 0.001) and 72% more likely to develop ESRD (HR, 1.72; 95% CI, 1.33-2.22; P < 0.001). The association between insurance and outcomes varied by CKD stage.
conclusionsLack of insurance is an independent risk factor for early death and ESRD in this population at high risk of kidney disease. Considering the high morbidity and mortality and increasing cost associated with ESRD, access to appropriate health insurance coverage is warranted.
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