CKD Prevalence Among Patients With and Without Type 2 Diabetes: Regional Differences in the United States

ABSTRACT Rationale and Objective Regional variation of chronic kidney disease (CKD) in patients with or without type 2 diabetes mellitus (T2DM) is not well characterized. Study Design Spatial and temporal comparative analysis. Setting and Participants Used MarketScan® databases to identify patients in the US with CKD overall and subgroups with and without T2DM. Outcomes Spatial patterns in CKD prevalence by year, regional clusters of CKD between years, and characteristics of patients in high-prevalence states. Analytical Approach Geo-mapping was used to visualize state-level data for CKD prevalence generated from 2013 to 2018. We used univariate LISA to evaluate geographic differences in prevalence, differential LISA for the change of CKD over time, and chi-square to identify patient characteristics in the top 20th percentile states for prevalence of CKD. Results In univariate LISA, low-low clusters, where a state has low CKD prevalence and the surrounding states have below average CKD prevalence, were observed in the northwest throughout the study period regardless of T2DM status, indicating consistently low prevalence of CKD clustered in these areas. High-high clusters were observed, regardless of T2DM status, in the southeast in more recent years, suggesting increased CKD prevalence in this region. Limitations Healthcare insurance enrollment may not be representative of the US; estimates were based on claims data that likely underestimated the true prevalence. Conclusion Geographical disparities in CKD prevalence appear increasingly magnified, with an increase in the Southeastern US. This increase is especially problematic given that patients with CKD in high-prevalence states experience a greater likelihood of chronic conditions than the rest of the US.