KEEP Summary Figures S32. Am J Kidney Dis. 2011;57(3)(suppl 2):S32-S56

Transcription

1 21 Summary Figures S32

2 Definitions DATA ANALYSES DIABETES Self-reported diabetes, self reported diabetic retinopathy, receiving medication for diabetes, or elevated blood glucose (WHO); fasting blood sugar 126 mg/dl or nonfasting blood sugar 2 mg/dl, or A1c 7% (if available) SELF-REPORTED DIABETES Self-reported diabetes or self-reported diabetic retinopathy GLYCEMIC CONTROL Fasting blood sugar <126 mg/dl or non-fasting blood sugar <2 mg/dl, and A1c <7% (if available) HYPERTENSION Self reported history hypertension, receiving a medication for hypertension, or elevated blood pressure (JNC7): Diabetes or ; systolic 13 mmhg or diastolic 8 mmhg, otherwise systolic 14 mmhg or diastolic 9 mmhg SELF-REPORTED HYPERTENSION Self-reported hypertension BLOOD PRESSURE CONTROL Diabetes or : systolic <13 mmhg and diastolic <8 mmhg, otherwise systolic <14 mmhg and diastolic <9 mmhg HIGH CHOLESTEROL Self-reported high cholesterol or receiving medication for cholesterol, or cholesterol level >2 mg/dl SELF-REPORTED HIGH CHOLESTEROL Self-reported high cholesterol CHOLESTEROL CONTROL Total cholesterol levels of 2 mg/dl SELF-REPORTED CARDIOVASCULAR DISEASE Participant reports any of the following cardiac events: heart attack, bypass surgery, heart angioplasty, stroke, heart failure, abnormal heart rhythm, or PVD (only for version 2) MICROALBUMINURIA Albumin/creatinine ratio 3 mg/g CHRONIC KIDNEY DISEASE egfr <6 ml/min/1.73 m 2 or egfr 6 ml/min/1.73 m 2 and albumin-creatinine ratio (ACR) 3 mg/g. GFR estimated using the IDMS-traceable 4-variable Modification of Diet in Renal Disease (MDRD) Study equation or Chronic Kidney Disease Epidemiology Collaboration equation (-EPI) for calibrated serum creatinine (Scr) values STAGES Stage 1: egfr 9 ml/min/1.73 m 2, and ACR 3 mg/g Stage 2: egfr 6 89 ml/min/1.73 m 2, and ACR 3 mg/g Stage 3: egfr 3 59 ml/min/1.73 m 2 Stage 4: egfr ml/min/1.73 m 2 Stage 5: egfr <15 ml/min/1.73 m 2 ANEMIA WHO Male: hemoglobin <13 g/dl Female: <12g/dl KDOQI (26) Males: hemoglobin <13.5 g/dl Women <12g/dl BODY MASS INDEX CATEGORIES UW: underweight, BMI <18.5 N: normal, BMI OW: overweight, BMI OB: obese, BMI EOB: extremely obese, BMI 4 EDUCATIONAL STATUS GSL: Grade school or less SHS: Some high school HSG: High school graduate SC+: Some college, college graduate, post-graduate DATA ANALYSES SELF-REPORTED DIABETES To be classified as having self-reported diabetes, participants had to report being told by a doctor, at any time, that they had diabetes or sugar diabetes other than that related to pregnancy. Participants answering borderline to the question were classified as non-diabetic. SELF-REPORTED HYPERTENSION Self-reported hypertension was identified by an affirmative answer to the question: Have you ever been told by a doctor that you had hypertension, also called high blood pressure. SELF-REPORTED HIGH CHOLESTEROL Self-reported high cholesterol was identified by an affirmative answere to the question: Have you ever been told by a doctor or other health professional that your blood cholesterol level was high? SELF-REPORTED CARDIOVASCULAR DISEASE Participant reports any of the following cardiac events: coronary heart disease, angina/angina pectoris, heart attack, congestive heart failure, or stroke. MICROALBUMINURIA Albumin/creatinine ratio 3 mg/g CHRONIC KIDNEY DISEASE egfr <6 ml/min/1.73 m 2 or egfr 6 ml/min/1.73 m 2 and albumin-creatinine ratio (ACR) 3 mg/g. GFR estimated using the IDMS-traceable 4-variable Modification of Diet in Renal Disease (MDRD) Study equation or Chronic Kidney Disease Epidemiology Collaboration equation (-EPI) for calibrated serum creatinine (Scr) values STAGES Stage 1: egfr 9 ml/min/1.73 m 2, and ACR 3 mg/g Stage 2: egfr 6 89 ml/min/1.73 m 2, and ACR 3 mg/g Stage 3: egfr 3 59 ml/min/1.73 m 2 Stage 4: egfr ml/min/1.73 m 2 Stage 5: egfr <15 ml/min/1.73 m 2 ANEMIA WHO Male: hemoglobin <13 g/dl Female: <12g/dl KDOQI (26) Males: hemoglobin <13.5 g/dl Women <12g/dl BODY MASS INDEX CATEGORIES UW: underweight, BMI <18.5 N: normal, BMI OW: overweight, BMI OB: obese, BMI EOB: extremely obese, BMI 4 EDUCATIONAL STATUS GSL: Grade school or less HSG: High school graduate SC+: Some college, college graduate, post graduate S33

3 Program accessibility s.1 cumulative # of partic. (in 1,s) 1 124, Cumulative # of affiliates Cumulative number of eligible participants & affiliates, by year (2 29), N = 124,9 s.2 Geographic variations in the percent of participants, by state (2 29), N = 124,9 participants (%) (4.9) 1.97 to < to < to <1.3 Below.32 (.12) South Carolina Florida Indiana East Tennessee Mass./Rhode Isl./N. Hampshire/Vermont Virginia Utah Greater New York The Alleghenies Louisiana Kentucky Connecticut Georgia National Capital Area North Carolina Arizona Hawaii North Texas Ohio Minnesota/Dakotas Percent of participants s.3 Twenty largest affiliates, by percentage of participants screened (rank order) (2 29), N = 124,9 S34

4 Program accessibility s.a Total eligible participants, by year (2 29), N = 124, All All (%) ,4 1,85 1,391 1, ,77 1,19 9, ,491 1,977 2,393 2,939 3,984 3,685 2,87 3,5 2,698 25, ,97 2,651 3,422 4,69 6,438 6,592 5,9 6,113 5,949 43, ,2 2,29 2,382 3,328 4,769 5,111 4,968 5,562 5,574 35, > ,76 1,547 1,656 1,683 1,938 1,959 11, Missing Gender Male 1,959 2,57 2,944 4,142 5,879 5,684 5,27 5,85 5,547 39, Female 4,123 5,473 6,976 8,975 12,192 12,613 1,88 11,89 11,6 84,7 68. Missing Race White 2,284 3,14 4,31 5,793 9,28 9,8 8,131 9,261 8,738 59, Black 2,652 3,392 3,43 4,274 5,267 5,565 5,41 5,42 5,479 4, Other 967 1,358 1,851 2,969 3,414 2,942 2,332 2,6 2,91 21, Unknown/missing , Ethnicity Hispanic ,117 1,89 2,416 2,317 2,75 2,164 2,317 15, Non-Hispanic 5,464 7,332 8,85 11,228 15,713 15,984 13,944 15,531 14,882 18, Education Level 6 years ,51 1, , <12 years ,188 1,779 1,763 1,581 1,57 1,492 11, years 1,585 2,192 2,591 3,491 4,611 4,462 4,19 4,531 4,527 32, >12 years 1,629 2,155 2,775 3,459 4,675 4,351 3,815 4,4 4,272 31, years 1,143 1,463 1,913 2,53 3,614 3,814 3,228 3,683 3,738 25, >16 years ,132 1,467 2,145 2,453 2,19 2,299 2,117 15, Missing ,8 1.5 Health Insurance Status Yes 4,948 6,428 7,892 1,153 14,56 14,27 12,44 13,632 12,579 96, No 883 1,234 1,66 2,49 3,251 3,371 3,292 3,525 3,88 23, Missing , All 6,82 8,44 9,922 13,118 18,129 18,31 16,19 17,695 17, ,9. "." Zero values in this cell S35

5 Targeting high-risk populations % with self-reported diabetes All s.4 Self-reported diabetes in & participants (2 29), N= 12,883 ( ), N= 22,66 s.5 participants with diabetes Percent with diabetes (2 29), N= 124,484 All Percent aware s.6 participants with diabetes who are aware of their condition (2 29), N= 38,384 All Percent treated s.7 participants with diabetes who receive medication for their condition (2 29), N= 38,384 All S36

6 Targeting high-risk populations Percent with glycemic control All s.8 Glycemic control in participants with diabetes (2 29), N= 38,384 Percent with glycemic control All s.9 Glycemic control in participants with diabetes who are being treated for their condition (2 29), N= 17,227 Percent with glycemic control All s.1 Glycemic control in participants with diabetes who are not being treated for their condition (2 29), N= 21,157 S37

7 Targeting high-risk populations % with self-reported hypertension All s.11 Self-reported hypertension in & participants (2 29), N= 12,143 ( ), N= 22,366 s.12 participants with hypertension Percent with hypertension (2 29), N= 124,492 All Percent aware s.13 participants with hypertension who are aware of their condition (2 29), N= 87,198 All Percent treated s.14 participants with hypertension who receive medication for their condition (2 29), N= 87,198 All S38

8 Targeting high-risk populations Percent controlled s.15 Blood pressure control in participants with hypertension (2 29), N= 87,198 All Percent controlled s.16 Blood pressure control in participants with hypertension who are being treated for their condition (2 29), N= 53,795 All Percent controlled s.17 Blood pressure control in participants with hypertension not being treated for their condition (2 29), N= 33,43 All S39

9 Targeting high-risk populations % with self-reported high chol : age 2-3 All s.18 Self-reported high cholesterol in & participants (2 29), N= 55,431 ( ), N= 13,535. Percent with high cholesterol All s.19 participants with high cholesterol (2 29), N= 8,186. Percent aware s.2 participants with high cholesterol who are aware of their condition (2 29), N= 49,1. All Percent treated s.21 participants with high cholesterol who receive medication for their condition (2 29), N= 49,1. All S4

10 Targeting high-risk populations Percent controlled s.22 Cholesterol control in participants with high cholesterol (2 29), N= 49,1. All Percent controlled s.23 Cholesterol control in participants with high cholesterol who are being treated for their condition (2 29), N= 14,828 All Percent controlled s.24 Cholesterol control in participants with high cholesterol who are not being treated for their condition (2 29), N= 34,322 All S41

11 Targeting high-risk populations s.25 % with self-reported CVD Gender Race/ethnicity Self-reported cardiovascular disease in participants (2 29), N= 121,543 All s.26 Percent distribution of & participants, by BMI OW: 33.2 N: 21.5 UW:.9 EO: 8.8 OW: 33.6 N: 32.8 UW: 1.9 EOB: 5.1 (2 29), N= 122,962 ( ), N= 2,567 OB: 35.6 OB: 26.5 S42

12 Prevalence of : MDRD 75 s.27 Prevalence of in & participants (2 29), N= 19,251 ( ), N= 19,553 Percent with -EPI All Percent with microalbuminuria All s.28 Prevalence of microalbuminuria in & participants (2 29), N= 111,73 ( ), N= 2,573. S43

13 Prevalence of s.b Total eligible participants with, by stage: MDRD equation (2 29), N= 124,9 Stage 1 & Stage 2 & Non- Abnormal ACR Abnormal ACR Stage 3 Stages 4-5 Missing All , ,4 9, , , ,547 25, ,81 1,272 1,815 4, ,896 43, , ,915 8, ,168 35,225 >75 4, , ,747 Gender Male 26, ,893 5, ,7 39,737 Female 55,535 2,295 3,621 13, ,276 84,7 Missing Race White 38, ,566 12, ,579 59,648 Black 27,344 1,466 1,876 4, ,442 4,2 Other 15, ,19 2, ,959 21,393 Unknown/missing ,875 2,966 Ethnicity Hispanic 1, , ,461 15,626 Non-Hispanic 71,273 2,715 4,927 17,566 1,8 11,394 18,883 U.S. Census Region Northeast 19, ,316 4, ,981 28,87 Midwest 11, , ,97 18,157 South 39,44 1,597 2,69 8, ,325 59,948 West 11, , ,631 17,498 Missing U.S. Census Division New England 6, , ,644 1,688 Middle Atlantic 12, , ,337 18,182 East North Central 7, , ,277 West North Central 4, , ,88 South Atlantic 19, ,31 4, ,221 3,911 East South Central 1, , ,339 15,983 West South Central 8, , ,765 13,54 Mountain 6, , ,656 Pacific 4, ,842 Missing Smoking Yes 3,846 1,361 2,358 7, ,444 48,231 No 48,281 1,759 2,971 1, ,551 71,564 Missing 2, ,714 Education Level 6 years 3, , ,784 <12 years 7, , ,474 11, years 2, ,511 5, , 32,18 >12 years 21, ,345 4, ,557 31, years 17, , 3, ,556 25,126 >16 years 1, , ,489 15,182 Missing 1, ,8 Health Insurance Status Yes 62,37 2,176 4,268 16, ,517 96,299 No 16, ,45 1, ,657 23,586 Missing 2, ,617 Doctor Status Yes 69,82 2,68 4,91 17,581 1,12 11,481 17,475 No 1, ,92 14,431 Missing 1, ,63 All 81,952 3,252 5,514 18,846 1,9 13, ,9 "." Zero values in this cell S44

14 Prevalence of MDRD s.29 Prevalence of in & participants, by stage (2 29), N= 11,342 ( ), N= 19,553 1 Percent with -EPI All Stage 1 Stage 2 Stage 3 Stages 4-5 s.3 MDRD 8 6 Prevalence of in & participants, by risk factor (2 29), N= 19,765 ( ), N= 19,354 Percent with EPI All No /DM /HTN /DM/HTN /Other S45

15 Prevalence of s.c Total eligible participants with, by stage: -EPI equation (2 29), N= 124,9 Stage 1 & Stage 2 & Non- Abnormal ACR Abnormal ACR Stage 3 Stages 4-5 Missing All , ,49 9, ,78 1, ,622 25, ,18 1,645 1,615 2, ,27 43, , ,918 7, ,2 35,225 >75 4, , ,747 Gender Male 26,856 1,18 1,725 4, ,546 39,737 Female 57,532 3,9 3,156 1, ,491 84,7 Missing Race White 4,452 1,36 2,3 1, ,767 59,648 Black 27,467 1,752 1,616 3, ,443 4,2 Other 15,548 1, , ,24 21,393 Unknown/missing ,875 2,966 Ethnicity Hispanic 1, , 15,626 Non-Hispanic 73,433 3,5 4,386 14,868 1,82 11,69 18,883 U.S. Census Region Northeast 19, ,18 3, ,47 28,87 Midwest 12, , ,918 18,157 South 4,482 2,36 2,289 7, ,461 59,948 West 11, , ,672 17,498 Missing U.S. Census Division New England 6, , ,686 1,688 Middle Atlantic 12, , ,361 18,182 East North Central 7, , ,277 West North Central 4, , ,88 South Atlantic 2, ,143 3, ,38 3,911 East South Central 11, , ,352 15,983 West South Central 8, , ,81 13,54 Mountain 7, , ,656 Pacific 4, ,842 Missing Smoking Yes 31,771 1,742 2,96 6, ,5 48,231 No 49,717 2,291 2,613 8, ,695 71,564 Missing 2, ,714 Education Level 6 years 4, , ,784 <12 years 7, , ,492 11, years 21,4 1,18 1,387 4, ,567 32,18 >12 years 21,831 1,117 1,165 3, ,68 31, years 18, , ,622 25,126 >16 years 1, , ,526 15,182 Missing 1, ,8 Health Insurance Status Yes 64,292 2,88 3,846 13, ,72 96,299 No 17,288 1, , ,698 23,586 Missing 2, ,617 Doctor Status Yes 71,966 3,461 4,37 14,887 1,85 11,76 17,475 No 1, ,924 14,431 Missing 1, ,63 All 84,388 4,189 4,881 15,782 1,16 14,19 124,9 "." Zero values in this cell S46

16 as a disease multiplier MDRD:, No s.31 Self-reported diabetes in & participants with or without (2 29), N= 18,755 ( ), N= 19, Percent with self-reported diabetes * -EPI: No * All anic S47

17 as a disease multiplier MDRD:, No s.32 Self-reported hypertension in & participants with or without (2 29), N= 18,755 ( ),N= 19, Percent with self-reported hypertension EPI: No All anic S48

18 as a disease multiplier MDRD:, No s.33 Self-reported high cholesterol in & participants with or without (2 29), N= 52,644 (2 29), N= 11,781 Percent with self-reported high cholesterol : 37.2 age 2-3 -EPI: No : age All anic S49

19 as a disease multiplier MDRD: No Gender Race/ethnicity s.34 Self-reported cardiovascular disease in KEEp participants with or without (2 29), N= 19, % with self-reported CVD 1 -EPI No 1 All MDRD:, No Gender s.35 BMI 3 kg/m 2 in & participants with or without (2 29), N= 19,14 ( ), N=19, Percent with BMI 3kg/m EPI: No All Male Female S

20 as a disease multiplier Percent of participants with anemia MDRD: WHO anemia EPI 3 2 KDOQI anemia s.36 Anemia (WHO & KDOQI definitions) in & participants with or without (2 29), N= 18,967 ( ), N= 19, All No All No MDRD: WHO anemia 8 Male 6 Female s.37 Anemia (WHO & KDOQI definitions) in & participants, by stage & gender KDOQI anemia * (2 29), N= 18,967 ( ), N= 19, Percent of participants with anemia EPI : WHO anemia Male Female KODQI anemia * * All Stage 1 Stage 3 No Stage 2 Stages 4-5 All * Stage 1 Stage 3 No Stage 2 Stages 4-5 S51

21 as a disease multiplier s.d Odds ratio (OR) of, by risk factor (2 29), N= 49,662 MDRD equation OR Low Upper P-value < < <.1 Male Race White 1. Black <.1 Other Hispanic <.1 Self-reported diabetes <.1 Self-reported hypertension <.1 Self-reported high cholesterol Cardiovascular disease <.1 BMI 3 kg/m <.1 Anemia (WHO definition) <.1 Insurance EPI equation OR Low Upper P-value < <.1 Male Race White 1. Black <.1 Other Hispanic <.1 Self-reported diabetes <.1 Self-reported hypertension <.1 Self-reported high cholesterol Cardiovascular disease <.1 BMI 3 kg/m <.1 Anemia (WHO definition) <.1 Insurance S52

22 Education & insurance HSG: 26.2 SHS: 9.6 GSL: 5.5 HSG: 26.1 GSL: 2.7 s.38 Percent distribution of & participants, by educational status (2 29), N= 122,658 ( ), N= 22,553 SC SC+: 53.2 Percent with insurance Gender s.39 Insurance coverage in & participants, by age & gender (2 29), N= 124,43 ( ), N= 22,3 All Male Female Non- Medicare: 39 Mcare with other than Mcaid: 11.9 Medicare 11.4 Unknown or missing: 34.5 Mcare/Mcaid: 3.3 s.4 Percent distribution of types of insurance in participants reporting they have insurance (2 29), N= 124,9 Percent with insurance s.41 Insurance coverage in & participants, by race & ethnicity (2 29), N= 1 21,536 race, N= 124,2 ethnicity ( ), N= 22,3 White Black Other Hispanic S53

23 RRT & mortality outcomes s.e Hazard ratio of RRT, controlled by risk factors (2 29), N= 96,39 s.f Hazard ratio of death, controlled by risk factors (2 29), N= 11,417 Estimate SE P-value Hazard ratio <.1.41 Male < Race White 1. Black Other Hispanic Self-reported diabetes Self-reported hypertension Cardiovascular disease BMI 3 kg/m Anemia (WHO definition) < Insurance egfr(continuous) -.9. <.1.91 ACR>=3mg/g < MDRD Study Equation Estimate SE P-value Hazard ratio < < < Male.49.4 < Race White 1. Black Other Hispanic Self-reported diabetes.41.4 <.1 1. Self-reported hypertension Cardiovascular disease.49.4 < BMI 3 kg/m Anemia (WHO definition).61.5 < Insurance by MDRD non- 1. stage < stage < stage < EPI Equation Estimate SE P-value Hazard ratio < < < Male.48.4 < Race White 1. Black Other Hispanic Self-reported diabetes.4.4 <.1 1. Self-reported hypertension Cardiovascular disease.49.4 < BMI 3 kg/m Anemia (WHO definition).59.5 < Insurance by -EPI non- 1. stage < stage < stage <.1 2. S54

24 RRT & mortality outcomes Rate per 1, patient years All s.42 Rates of renal replacement therapy (RRT) in participants, by age, gender, race & ethnicity (2 29), N= 14,822 Rate per 1, patient years MDRD equation Stage 1 Stage 2 Stage 3-5 -EPI equation Stage 1 Stage 2 Stages 3-5 Rate per 1, patient years All s.43 Mortality rates in participants, by age, gender, & race & ethnicity (2 29), N= 19,83 Rate per 1, patient years MDRD equation Stage 1 Stage 2 Stages 3-5 -EPI equation Stage 1 Stage 2 Stages 3-5 S55

25 Access, follow-up & intervention 88.2 Gender Race/ethnicity s.44 participants with a physician Percent with a physician (2 29), N= 119,13 All Male Female White Black Other Hisp % completing follow-up form s.45 follow-up response rate (%) (2 29) Reasons for seeing a physician (%) BP Glucose Urine egfr Hgb Cholesterol Other s.46 Reasons for seeing a physician in participants who return their follow-up forms (2 29), N= 3,216 S56