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Insights into Geographic Patterns, Urban-Rural Contrasts, and Health Care Disparities in Glomerular Disease Incidence in a Canadian Province

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Název: Insights into Geographic Patterns, Urban-Rural Contrasts, and Health Care Disparities in Glomerular Disease Incidence in a Canadian Province
Autoři: Bhanu Prasad, Aditi Sharma, Aarti Garg, Abdul Raouf, Joanne Kappel, Matthew Patterson, Arenn Jauhal, Pouneh Dokouhaki
Zdroj: Kidney Medicine, Vol 7, Iss 12, Pp 101138- (2025)
Informace o vydavateli: Elsevier, 2025.
Rok vydání: 2025
Sbírka: LCC:Diseases of the genitourinary system. Urology
Témata: Glomerular disease, glomerulonephritis, hemodialysis, kidney biopsy, kidney failure, kidney pathology, Diseases of the genitourinary system. Urology, RC870-923
Popis: Rationale & Objective: Glomerular diseases (GDs) are a group of immune-mediated or genetic diseases that involve the filtering units of the kidneys, or glomeruli. Using centralized provincial kidney pathology records and census data, we aimed to examine the incidence and temporal trend of GDs in Saskatchewan, Canada and understand rural/urban differences in GD distribution. Study Design: Population-based epidemiologic study. Setting & Participants: All adult patients who underwent kidney biopsies in Saskatchewan, Canada, from 2002-2018. Exposures or Predictors: Biopsy diagnosis, 3-digit postal codes, laboratory parameters, dialysis initiation dates, and mortality data. Outcomes: Incidence of primary GD, dialysis initiation, and all-cause mortality. Analytical Approach: Regional variations in GD were analyzed using SaTScan v10.1.3 software. Incidence trends, rural/urban differences, and geospatial clustering were evaluated. Ethics approval was obtained from the provincial research and ethics board. Results: A total of 1,372 of 3,509 kidney biopsies met the inclusion criteria. GD incidence increased from 4.6 to 13.6 per 100,000 persons from 2002 to 2018 (P < 0.001). GD incidence was higher in rural areas than in urban areas (10.73 vs 8.92 per 100,000 per year, P < 0.001). Significantly higher dialysis progression rates were seen for rural and remote areas (P < 0.001). A geospatial cluster of 345.7 km2 was identified for lupus nephropathy, with an incidence rate ratio of 1.73, a relative risk of 2.7, and a log likelihood ratio of 13.87. Limitations: Biopsies were dependent on the threshold of the ordering physician. Likely, frail and elderly patients and patients with early onset glomerulonephritis, late presentations, and higher bleeding risk were not biopsied, which led to an underrepresentation of these groups. Conclusions: The incidence and relative burden of GDs have increased over time in Saskatchewan, with notable rural/urban differences. We identified a geographic cluster for lupus nephropathy encompassing rural and urban areas. Patients in rural and remote areas had higher dialysis transition rates, and mortality rates were relatively higher in urban areas. Addressing and understanding the multifaceted factors driving these disparities are essential steps toward easing the burden of GDs on impacted communities. Plain-Language Summary: Glomerular diseases are a group of immune-mediated or genetic diseases that involve the glomeruli, the filtering units of the kidneys. We conducted a population-level study based on 1,372 kidney biopsies performed on adults from 2002-2018 in Saskatchewan, Canada. We collected and analyzed data on age, sex, 3-digit postal codes, date of biopsy, glomerular disease diagnosis, dialysis start date, and death. The incidence of glomerular diseases increased from 4.6 to 13.6 per 100,000 persons over the study period, with higher rates in rural areas. Patients in rural and remote areas also had higher rates of dialysis progression, whereas mortality rates were higher in urban areas. A geospatial cluster was identified for lupus nephropathy encompassing both rural and urban areas. This study highlights understanding and addressing the factors behind these differences.
Druh dokumentu: article
Popis souboru: electronic resource
Jazyk: English
ISSN: 2590-0595
Relation: http://www.sciencedirect.com/science/article/pii/S2590059525001748; https://doaj.org/toc/2590-0595
DOI: 10.1016/j.xkme.2025.101138
Přístupová URL adresa: https://doaj.org/article/6f7b3496349f4c85b50fabac7e3b418b
Přístupové číslo: edsdoj.6f7b3496349f4c85b50fabac7e3b418b
Databáze: Directory of Open Access Journals
Popis
Abstrakt:Rationale & Objective: Glomerular diseases (GDs) are a group of immune-mediated or genetic diseases that involve the filtering units of the kidneys, or glomeruli. Using centralized provincial kidney pathology records and census data, we aimed to examine the incidence and temporal trend of GDs in Saskatchewan, Canada and understand rural/urban differences in GD distribution. Study Design: Population-based epidemiologic study. Setting & Participants: All adult patients who underwent kidney biopsies in Saskatchewan, Canada, from 2002-2018. Exposures or Predictors: Biopsy diagnosis, 3-digit postal codes, laboratory parameters, dialysis initiation dates, and mortality data. Outcomes: Incidence of primary GD, dialysis initiation, and all-cause mortality. Analytical Approach: Regional variations in GD were analyzed using SaTScan v10.1.3 software. Incidence trends, rural/urban differences, and geospatial clustering were evaluated. Ethics approval was obtained from the provincial research and ethics board. Results: A total of 1,372 of 3,509 kidney biopsies met the inclusion criteria. GD incidence increased from 4.6 to 13.6 per 100,000 persons from 2002 to 2018 (P < 0.001). GD incidence was higher in rural areas than in urban areas (10.73 vs 8.92 per 100,000 per year, P < 0.001). Significantly higher dialysis progression rates were seen for rural and remote areas (P < 0.001). A geospatial cluster of 345.7 km2 was identified for lupus nephropathy, with an incidence rate ratio of 1.73, a relative risk of 2.7, and a log likelihood ratio of 13.87. Limitations: Biopsies were dependent on the threshold of the ordering physician. Likely, frail and elderly patients and patients with early onset glomerulonephritis, late presentations, and higher bleeding risk were not biopsied, which led to an underrepresentation of these groups. Conclusions: The incidence and relative burden of GDs have increased over time in Saskatchewan, with notable rural/urban differences. We identified a geographic cluster for lupus nephropathy encompassing rural and urban areas. Patients in rural and remote areas had higher dialysis transition rates, and mortality rates were relatively higher in urban areas. Addressing and understanding the multifaceted factors driving these disparities are essential steps toward easing the burden of GDs on impacted communities. Plain-Language Summary: Glomerular diseases are a group of immune-mediated or genetic diseases that involve the glomeruli, the filtering units of the kidneys. We conducted a population-level study based on 1,372 kidney biopsies performed on adults from 2002-2018 in Saskatchewan, Canada. We collected and analyzed data on age, sex, 3-digit postal codes, date of biopsy, glomerular disease diagnosis, dialysis start date, and death. The incidence of glomerular diseases increased from 4.6 to 13.6 per 100,000 persons over the study period, with higher rates in rural areas. Patients in rural and remote areas also had higher rates of dialysis progression, whereas mortality rates were higher in urban areas. A geospatial cluster was identified for lupus nephropathy encompassing both rural and urban areas. This study highlights understanding and addressing the factors behind these differences.
ISSN:25900595
DOI:10.1016/j.xkme.2025.101138