Chronic Kidney Disease Among Older Adults Varies Across US Counties

August 2023

Collecting information about the geographic distribution of chronic kidney disease (CKD) in the United States is a core function of CDC’s Kidney Disease Surveillance System.¹ This allows identification of geographic hot spots among adults 65 years or older. The data also help identify potential reasons for these hotspots, which can guide public health action.

In 2019, the prevalence of diagnosed CKD across the United States ranged from 0% to 57.1%, with an average of 22.1%, (Figure, Panel A). Prevalence was higher in the Hawaiian Islands, the Southeastern states, and the Appalachian region. These findings are based on data from the 2019 Medicare 5% random sample. Diagnosed CKD, diabetes, and hypertension were defined using International Classification of Diseases (ICD) codes.

Counties with high prevalence of CKD also had high prevalence of diagnosed diabetes and hypertension among Medicare beneficiaries (Figure, Panels B and C). Both diabetes and hypertension are well-known risk factors for the development of CKD. Individually and in combination, these three conditions increase a person’s risk of complications such as cardiovascular events, kidney failure and death.²

One limitation of the Medicare data, which are based on ICD diagnosis codes, is that the prevalence of CKD may be underestimated in the absence of laboratory data.

Surveillance Data Can Support Actions to Prevent CKD and Risk Factors

The data collected by CDC’s Kidney Disease Surveillance System can help focus public health actions on areas with the highest prevalence of CKD and its risk factors, such as diabetes and hypertension.

These efforts could include population-based screening and intervention programs designed to detect and manage all three conditions earlier. Social and environmental determinants of health could also be addressed to help reduce risk and prevent these conditions.^3,4

Figure. Geographic Distribution of the Prevalence of Diagnosed Chronic Kidney Disease

References:

1. Centers for Disease Control and Prevention. Kidney Disease Surveillance System. Prevalence of Diagnosed CKD Among Medicare Beneficiaries Aged ≥ 65 Years, by US State and County. Accessed August 9, 2023. https://nccd.cdc.gov/CKD/detail.aspx?Qnum=Q705
2. Lea JP, Nicholas SB. Diabetes mellitus and hypertension: key risk factors for kidney disease. J Natl Med Assoc. 2002;94(8 suppl):7S–15S. PMID: 12152917; PMCID: PMC2594170
3. US Preventive Services Task Force. Recommendation Topics. Accessed August 9, 2023. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics
4. Hall YN. Social determinants of health: addressing unmet needs in nephrology. Am J Kidney Dis. 2018;72(4):582–591. doi:10.1053/j.ajkd.2017.12.016. Epub 2018 Mar 13. PMID: 29548780