Association of Neighborhood Social Determinants of Health with Acute Kidney Injury during Hospitalization
Authors: Ghazi Lama , Parcha Vibhu , Takeuchi Tomonori , Butler Catherine R. , Baker Elizabeth , Oates Gabriela R. , Juarez Lucia D. , Nassel Ariann F. , Rahman AKM Fazlur , Siew Edward D. , Chen Xinyuan , Gutierrez Orlando M. , Neyra Javier A. 
Published: September 2024

Key Points

AKI is common among hospitalized patients. However, the contribution of neighborhood social determinants of health to AKI risk is not known.We found that among 26,769 hospitalized patients, 26% developed AKI. Patients who lived in the most disadvantaged areas (highest tertile of Area Deprivation Index) had a 10% greater odds of developing AKI than counterparts in the lowest Area Deprivation Index tertile. Patients who lived in rural areas had 25% greater odds of not recovering from AKI by hospital discharge.This study demonstrates an association between neighborhood disadvantage and rurality on the development of AKI and lack of recovery from AKI. Further work is needed to understand the mechanisms of these associations and to develop community-level interventions to mitigate the health care burden of AKI for disadvantaged populations.

Background
AKI is common among hospitalized patients. However, the contribution of social determinants of health (SDOH) to AKI risk remains unclear. This study evaluated the association between neighborhood measures of SDOH and AKI development and recovery during hospitalization.

Methods
This is a retrospective cohort study of adults without ESKD admitted to a large Southern US health care system from October 2014 to September 2017. Neighborhood SDOH measures included (1) socioeconomic status: Area Deprivation Index (ADI) scores, (2) food access: Low-Income, Low-Access scores, (3) rurality: Rural–Urban Commuting Area scores, and (4) residential segregation: dissimilarity and isolation scores. The primary study outcome was AKI on the basis of serum creatinine Kidney Disease Improving Global Outcomes criteria. Our secondary outcome was lack of AKI recovery (requiring dialysis or elevated serum creatinine at discharge). The association of SDOH measures with AKI was evaluated using generalized estimating equation models adjusted for demographics and clinical characteristics.

Results
Among 26,769 patients, 26% developed AKI during hospitalization. Compared with those who did not develop AKI, those who developed AKI were older (median 60 versus 57 years), more commonly men (55% versus 50%), and more commonly self-identified as Black (38% versus 33%). Patients residing in most disadvantaged neighborhoods (highest ADI tertile) had 10% (95% confidence interval, 1.02 to 1.19) greater adjusted odds of developing AKI during hospitalization than counterparts in least disadvantaged areas (lowest ADI tertile). Patients living in rural areas had 25% higher adjusted odds of lack of AKI recovery by hospital discharge (95% confidence interval, 1.07 to 1.46). Food access and residential segregation were not associated with AKI development or recovery.

Conclusions
Hospitalized patients from the most socioeconomically disadvantaged neighborhoods and from rural areas had higher odds of developing AKI and not recovering from AKI by hospital discharge, respectively. A better understanding of the mechanisms underlying these associations is needed to inform interventions to reduce AKI risk during hospitalization among disadvantaged populations.