Nativity, Racial/Ethnic, and Length of US Residence Differences in Chronic Kidney Disease: National Health and Nutrition Examination Survey 2011-March 2020

Rationale : The chronic kidney disease (CKD) burden in the US varies by race/ethnicity. It was unclear whether nativity status influences these disparities. This study compared CKD prevalence by nativity status, race and ethnicity, and length of US residence. Study Design: Cross-sectional analysis. Setting/Participants: We drew a weighted sample of 13,636 adults representing 155,147,141 Hispanic, White, Black, and Asian adults from the pooled 2011-March 2020 National Health and Nutrition Examination Survey (NHANES), which included 155,147,141 US-and foreign-born adults. Exposures : Nativity (US-or foreign-born), race/ethnicity, and length of US residence. Outcome : We defined CKD as eGFR <60mL/min/1.73m 2 or a urinary albumin-to-creatinine ratio ≥30 mg/g. Analytical Approach : Survey-weighted multivariable Poisson models estimated associations among nativity status, race, and ethnicity, length of US residence, and CKD, adjusting for covariates. Results : The prevalence of CKD among US-born adults was 14.0%, vs. 11.5% of foreign-born. Foreign-born adults were less likely to have CKD (prevalence rate ratio [PRR]: 0.75, 95% CI 0.60-0.93) than US-born adults, adjusting for age, sex, and socioeconomic factors. Black adults were more likely to have CKD than White adults (PRR: 1.44, 95% CI 1.23-1.68); this difference was greater among US-born adults (PRR: 1.48, 95% CI 1.25-1.76). Among Hispanic and Asian adults, age-and sex-adjusted prevalence of CKD increased with longer length of residence in the US. Conclusions : There are clear CKD disparities related to nativity location and length of US residence, and these vary by race/ethnicity. Interventions addressing the unique challenges faced by populations most at risk for CKD, such as access to healthcare barriers and socioeconomic disparities, may help mitigate the burden of CKD and promote health equity.