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Author Notes:

Corresponding author: Laura Plantinga, laura.plantinga@emory.edu

LP carried out the analysis and draft the manuscript; VJH participated in the design and coordination of the study and provided feedback on the written manuscript, SJ, PM, DR, DTL, and DGW provided feedback on the analyses and drafts of the manuscript; GH served as principal investigator of the REGARDS study and provided feedback on drafts of the manuscript; and WMM served as primary mentor to LP and helped to design and perform the analyses and draft the manuscript.

All authors read and approved the final manuscript.

We thank the participants and staff of the REGARDS study.

The authors thank the other investigators, the staff, and the participants of the REGARDS study for their valuable contributions.

A full list of participating REGARDS investigators and institutions can be found at http://www.regardsstudy.org.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke or the National Institutes of Health.

Representatives of the funding agency have been involved in the review of the manuscript but not directly involved in the collection, management, analysis or interpretation of the data.

The authors declare that they have no competing interests.


Research Funding:

This research project is supported by a cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Services.

Additional funding was provided by an investigator-initiated grant-in-aid from Amgen Inc. to Dr. Warnock.

Association of duration of residence in the southeastern United States with chronic kidney disease may differ by race: the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study


Journal Title:

International Journal of Health Geographics


Volume 12, Number 17


, Pages 1-12

Type of Work:

Article | Final Publisher PDF


Background Prior evidence suggests that longer duration of residence in the southeastern United States is associated with higher prevalence of diabetes and hypertension. We postulated that a similar association would exist for chronic kidney disease (CKD). Methods In a national population-based cohort study that enrolled 30,239 men and women ≥ 45 years old (42% black/58% white; 56% residing in the Southeast) between 2003 and 2007, lifetime southeastern residence duration was calculated and categorized [none (0%), less than half (>0-< 50%), half or more (≥50-< 100%), and all (100%)]. Prevalent albuminuria (single spot urinary albumin:creatinine ratio of ≥30 mg/g) and reduced kidney function (estimated glomerular filtration rate <60 ml/min/1.73 m2) were defined at enrollment. Incident end-stage renal disease (ESRD) during follow-up was identified through linkage to United States Renal Data System. Results White and black participants most often reported living their entire lives outside (35.7% and 27.0%, respectively) or inside (27.9% and 33.8%, respectively) the southeastern United States. The prevalence of neither albuminuria nor reduced kidney function was statistically significantly associated with southeastern residence duration, in either race. ESRD incidence was not statistically significantly associated with all vs. none southeastern residence duration (HR = 0.50, 95% CI, 0.22-1.14) among whites, whereas blacks with all vs. none exposure showed increased risk of ESRD (HR = 1.63, 95% CI, 1.02-2.63; PraceXduration = 0.011). Conclusions These data suggest that blacks but not whites who lived in the Southeast their entire lives were at increased risk of ESRD, but we found no clear geographic pattern for earlier-stage CKD.

Copyright information:

© 2013 Plantinga et al.; licensee BioMed Central Ltd.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 2.0 Generic License (http://creativecommons.org/licenses/by/2.0/).

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