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Home > Social Determinants of Health and Kidney Disease > Social and Environmental Determinants of Health and Chronic Kidney Disease > Average Daily PM2.5 Air Pollution and CKD in the U.S. Medicare Population, by County

Average Daily PM2.5 Air Pollution and CKD in the U.S. Medicare Population, by County

Average Daily PM2.5 Air Pollution and CKD in the U.S. Medicare Population, by County

The map shows the overlay of the average daily particulate matter 2.5 (PM2.5) air pollution level and the percentage of diagnosed chronic kidney disease (CKD) patients among the Medicare population across counties (n=3,043) in the United States. The average daily PM2.5 and the percentage of diagnosed CKD patients varied across counties (PM2.5 mean=8.7 μg/m3) and CKD (mean=22.1%). The county-level average daily PM2.5 and the county-level prevalence of CKD are high in counties in California, the Rust Belt region, and the Southern region.

Data Source: CMS & EPA
Average daily PM2.5, by county (2014)
Population in poverty by county
State: 
County: 
Data: 

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Tertiles were used for both variables to create three equally sized groups for display on the map. Definitions for low, mid, and high are displayed below. The average daily PM2.5 ranged from 2.7 µg/m3 to 15.1 µg/m3 and the percentage of diagnosed CKD patients among the Medicare population ranged from 0% to 57.1%. Data are not adjusted.

Average daily PM2.5 air pollution - Low: <8 µg/m3; Mid: 8 to 10 µg/m3; High: >10 µg/m3

Patients with diagnosed CKD - Low: <20%; Mid: 20% to 24%; High: >24%

The EPA data set provides modeled predictions of PM2.5 (fine particulate matter) levels from the EPA’s Downscaler model. CDC's National Environmental Public Health Tracking Network uses these data to generate air quality measures.

CMS maintains claims data on beneficiaries aged 65 years and older, those with disabilities, and those with end-stage kidney disease. A 5% random sample of beneficiaries who had at least one inpatient or outpatient visit during the calendar year—over 1.8 million annually—of Medicare claims data was used. Diagnoses for medical conditions in Medicare data come from claims submitted by providers for Medicare fee-for-service Part A (hospital insurance) and Part B (medical insurance). The analysis sample was limited to beneficiaries aged 65 years or older who had Parts A and B coverage for the entire calendar year and had at least one inpatient or outpatient visit in that calendar year. Between 20% and 37% of beneficiaries each year used Part C (managed care/Medicare Advantage plans) and are excluded because their care was paid on a fixed amount and claims with diagnoses are unavailable. Chronic kidney disease, diabetes, and hypertension are defined by at least one diagnosis code for each condition.

FieldData
Description of Indicator

County and state estimates of diagnosed CKD among Medicare Beneficiaries aged ≥ 65 years.

Dataset

Medicare 5% random sample.

Population

Medicare fee-for-service beneficiaries aged ≥ 65 years.

Years Included

2019

Numerator

Medicare fee-for-service beneficiaries aged ≥ 65 years with diagnosed CKD from claims by any of the ICD-9-CM or ICD-10-CM CKD codes listed below.

Denominator

Medicare fee-for-service beneficiaries aged ≥ 65 years with full-year Parts A and B enrollment and at least one inpatient or outpatient visit in the given calendar year.

Definition of CKD

ICD-9-CM and ICD-10-CM diagnosis codes.

ICD-10-CM Codes for CKD

A18.11, A52.75, B52.0, C64.x, C68.9, D30.0x, D41.0x-D41.2x, D59.3, E08.2x, E09.2x, E10.2x, E10.65, E11.2x, E11.65, E13.2x, E74.8, I12.xx, I13.0, I13.1x, I13.2, K76.7, M10.3x, M32.14, M32.15, N01.x-N08.x, N13.1, N13.1x-N13.39, N14.x,N15.0, N15.8, N15.9, N16, N17.x, N18.1-N18.5, N18.8, N18.9, N19, N25.xx, N26.1, N26.9, O10.4xx, O12.xx, O26.83x, O90.89, Q61.02, Q61.1x-Q61.8, Q26.0-Q26.39, R94.4
(x and xx stand for all the codes within the main diagnosis).

ICD-9-CM Codes for CKD

016.0, 095.4, 189.0,189.1, 189.9, 236.91, 250.4, 250.41, 250.42, 250.43, 271.4, 274.10, 283.11, 403.xx, 404.xx, 405.01, 405.11, 440.1, 442.1, 447.3, 453.3, 573.4, 580.xx, 581.xx, 582.xx, 583.xx, 584.5, 585.x, 587.xx, 588.xx, 590.xx, 591, 592.x, 593.xx, 642.1, 646.2, 753.xx, 794.4.

Diabetes

Diabetes is determined by the presence of an ICD-9-CM code (250.xx, 357.2, 336.41, 362.01, 362.02) or ICD-10-CM (E08.xx, E09.xx, E10.xx, E11.xx, E13.xx) on at least one claim during the given calendar year.

Hypertension

Hypertension is determined by the presence of an ICD-9-CM code (401.x through 405.x) or ICD-10-CM code (H35.03x, I10.xx, I11.xx, I12.xx, I13.xx, I15.xxx, I67.4, N26.2) on at least one claim during the given calendar year.

Limitations of Indicator

As a measure of prevalence, the use of ICD-9-CM or ICD-10-CM diagnosis codes will likely underestimate CKD.

Analytical Considerations

Counties with 10 or fewer beneficiaries have been suppressed to protect potential identification of individuals.


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