Trust, Conflict, and Engagement in Occupational Health: North American Epidemiologists Conduct Occupational Study in Communities Affected by Chronic Kidney Disease of Unknown Origin (CKDu)

COVID-19 and CKD: Employment, Food Security and Healthcare in El Salvador

Background

In Central America, the COVID-19 pandemic coexists with a devastating epidemic of chronic kidney disease of unknown origin. The consequences of these overlapping health crises remain largely unknown.

Methods

We assessed vulnerability to and impact of the first wave of COVID-19 on participants in a cohort study of chronic kidney disease (CKD) in El Salvador (n = 229). Participants were contacted by phone during August and September 2020. We queried changes to employment, healthcare access, household income and food security due to the pandemic (from March 2020 until the time of the interview) and COVID-19-associated symptoms during that time.

Findings

We reached 94% of the cohort (n = 215). Nearly 40% of participants reported an unexpected change in employment or work activities and 8.8% reported new unemployment due to the pandemic. Participants with CKD (n = 27) had higher odds of reporting new income insecurity, food insecurity, and reductions in medical care access due to the pandemic. COVID-19-associated symptoms (an approximation of disease) were reported in 7.0% (n = 15). Participants with CKD were more likely to report COVID-19-associated symptoms compared to those without CKD, although these differences were not statistically significant.

Conclusions

Overall, participants with CKD suffered greater economic consequences as a result of the pandemic and may have experienced higher incidence of COVID-19 disease, although laboratory diagnostics would be required to draw this conclusion. Longitudinal analyses are required to comprehensively evaluate the implications of the pandemic for individuals with CKD in Central America.

Temporal trends in prevalence and mortality for chronic kidney disease in China from 1990 to 2019: an analysis of the Global Burden of Disease Study 2019

Background

This study aimed to characterize the temporal trends of chronic kidney disease (CKD) burden in China during 1990-2019, evaluate their age, period and cohort effects, and predict the disease burden for the next 10 years.

Methods

Data were obtained from the Global Burden of Disease (GBD) 2019 study. Join-point regression model was used to estimate the average annual percentage change (AAPC) of CKD prevalence and mortality, and the age-period-cohort analysis was used to estimate the age, period and cohort effects. We extended the autoregressive integrated moving average (ARIMA) model to predict the disease burden of CKD in 2020-2029.

Results

In 2019, there were 150.5 million cases of (10.6%) and 196 726 deaths from (13.8 per 100 000 general population) CKD in China. Between 1990 and 2019, the prevalence and mortality rate of CKD increased significantly from 6.7% to 10.6%, and from 8.3/100 000 to 13.8/100 000. The AAPC was estimated as 1.6% and 1.8%, respectively. Females had a higher CKD prevalence of CKD but a lower mortality rate. Setting the mean level of age, period and cohort as reference groups, the risk of developing CKD increased with age [RR_age(15-19) = 0.18 to RR_age(85-89) = 2.45]. The cohort risk was significantly higher in the early birth cohort [RR_{cohort(1905-1909)} = 1.56]. In contrast, the increase in age-specific CKD mortality rate after 60-64 years was exponential [RR_age(60-64) = 1.24]. The cohort-based mortality risk remained high prior to the 1945-1949 birth cohorts (RR_cohort ranging from 1.69 to 1.89) and then declined in the 2000-2004 birth cohort [RR_{cohort(2000-2004)} = 0.22]. The CKD prevalence and mortality are projected to rise to 11.7% and 17.1 per 100 000, respectively, by 2029.

Conclusions

To reduce the disease burden of CKD, a comprehensive strategy that includes risk factors prevention at the primary care level, CKD screening among the elderly and high-risk population, and access to high-quality medical services is required.

Where do you live and what do you do? Two questions that might impact your kidney health

In many cases the social determinants of health need to be assessed through their interaction with environmental factors. This review looks at the impact of physical location and occupation of individuals on their kidney health. It examines the effect of living at high altitude on kidney function and the relationship between extreme cold or hot temperatures and the incidence of kidney injury. It reviews as well the many occupations that have been linked to kidney disease in high-income and low-and-middle-income countries. As a conclusion, this overview proposes preventive recommendations that could be individualized based on weather, altitude, socio-economic level of the country and occupation of the individual.

High prevalence of chronic kidney disease of unknown etiology among workers in the Mesoamerican Nephropathy Occupational Study

BACKGROUND

Mortality from chronic kidney disease of unknown etiology (CKDu) is extremely high along the Pacific coast of Central America, particularly among sugarcane workers. The Mesoamerican Nephropathy Occupational Study (MANOS) is a prospective cohort study of CKDu among agricultural and non-agricultural workers in El Salvador and Nicaragua. The objective of this manuscript is to describe the MANOS cohort recruitment, baseline data collection, and CKDu prevalence after two rounds.

METHODS

Workers with no known diabetes, hypertension, or CKD were recruited from sugarcane, corn, plantain, brickmaking, and road construction industries (n = 569). Investigators administered questionnaires, collected biological samples, and observed workers for three consecutive workdays at the worksite. Serum specimens were analyzed for kidney function parameters, and used to calculate estimated glomerular filtration rate (eGFR). At six months, serum was collected again prior to the work shift. CKD at baseline is defined as eGFR ≤ 60 ml/min/1.73m2 at both timepoints. Age-standardized prevalence was calculated by industry, country, and demographic measures. Kidney function parameters were compared by CKD status.

RESULTS

Prevalence of CKD at baseline was 7.4% (n = 42). Age-standardized prevalence was highest in Salvadoran sugarcane (14.1%), followed by Salvadoran corn (11.6%), and Nicaraguan brickmaking (8.1%). Nicaraguan sugarcane had the lowest prevalence, likely due to kidney function screenings prior to employment.

CONCLUSION

Despite efforts to enroll participants without CKD, our identification of prevalent CKD among agricultural and non-agricultural workers in the MANOS cohort indicates notable kidney disease in the region, particularly among sugarcane workers.

Effects of New Media Use on Health Behaviors: A Case Study in China

Background:

Mass communication is one of the most important ways in health communication. The emergence of new media has changed the way people acquire health information and then their health behaviors. However, few studies have been conducted about complicated relations between media use and health behaviors under new media conditions and further systematic explanation is needed.

Methods:

A hypothesis model for the influence of WeChat use on health behaviors was constructed to explore the internal influencing mechanism of new media use on health behaviors. An empirical analysis on the internal influencing mechanism of WeChat use on health behaviors was carried out with a survey data consist of 463 young active users on famous online social network sites in China from March to June 2019.

Results:

New media use represented by WeChat has significant positive influence on health behaviors. Individuals who frequently use new media related to health have better health conditions than those who rarely use them. The improvement of health behaviors is mainly attributed to acquisition of health knowledge. Such effect is also mediated by the degree of individuals’ trust in health knowledge.

Conclusion:

This study not only discloses the influencing mechanism of new media use and health knowledge on health behaviors, but also confirms the value of new media in promoting public health communication and public health behaviors. Conclusions provide significant references in decision-making to develop effective guidance of public health.