How Where You Live Can Affect Your Health: A National Analysis of End-Stage Renal Disease Patients


A new Cleveland Clinic populations health study shows that residential life expectancy is associated with processes of care and health outcomes among patients with end-stage renal disease (ESRD). The findings suggest that community life expectancy may be an important factor to consider when developing personalized care and treatment plans for patients.

Previous research has examined the effect of single-factor ecological variables—such as median household income, social deprivation and income inequality—on ESRD outcomes. This study, led by Jesse Schold, PhD, Lerner Research Institute Department of Quantitative Health Sciences, is the first to investigate the association between residential life expectancy—a variable that captures many dimensions of risk and is a proxy for a host of socioeconomic, environmental, genetic and behavioral factors—and processes of care and patient outcomes across multiple treatment modalities.

The retrospective study cohort was made up of more than 600,000 patients registered to the United States Renal Data System (USRDS) from 2006 to 2013. Dr. Schold and his team collected and analyzed data from multiple sources to build their mathematical models. They used data from the Institute for Health Metrics and Evaluation to determine residential life expectancy at the time of ESRD onset for each patient. Residential life expectancy shows how long, on average, a person from within a defined geographic area is expected to live. The researchers used USRDS patient records to collect data about the type and quality of care they received and clinical health outcomes. Indicators of processes of care included whether the patient was under the care of a nephrologist, informed of kidney transplant options and the access type first used for outpatient dialysis. Clinical health outcomes included time to death following ESRD onset, whether the patient was placed on a deceased donor waiting list, received a living donor transplant and post-transplant graft failure or death.

Based on this data, the investigators found that patients living in areas with lower residential life expectancy had significantly poorer health outcomes and reduced incidence of important processes of care compared to patients living in higher life expectancy areas.

These findings suggest that residential life expectancy is a non-traditional risk factor that doctors can use to assess patient risk and inform tailored treatment protocols that help address individual patient needs. This is an example of how populations health and precision medicine should be considered in conjunction to deliver optimum clinical care. This study also underscores the need for public health and social policy development to eliminate health and care disparities that systematically place residents of some communities at higher risk than others.

The study was funded by the Laura and John Arnold Foundation and published in the American Journal of Kidney Diseases (AJKD). AJKD recognized the paper as one of four recipients of the "Editor's Choice" award, which recognizes outstanding articles published in 2018.