Time trends in the association of ESRD incidence with area-level poverty in the US population.

The objective of this study was to examine the temporal trends of the association between area-level poverty status and end-stage renal disease (ESRD) incidence. We hypothesized that the association between area-level poverty status and ESRD incidence has increased significantly over time. Patient data from the United States Renal Data System were linked with data from the 2000 and 2010 US census. Area-level poverty was defined as living in a zip code-defined area with ≥20% of households living below the federal poverty line. Negative binomial regression models were created to examine the association between area-level poverty status and ESRD incidence by time period in the US adult population while simultaneously adjusting for the distribution of age, sex, and race/ethnicity within a zip code. Time was categorized as January 1, 1995 through December 31, 2004 (Period 1) and January 1, 2005 through December 31, 2010 (Period 2). The percentage of adults initiating dialysis with area-level poverty increased from 27.4% during Period 1 to 34.0% in Period 2. After accounting for the distribution of age, sex, and race/ethnicity within a zip code, area-level poverty status was associated with a 1.24 (95% confidence interval [CI] 1.22, 1.25)-fold higher ESRD incidence. However, this association differed by time period with 1.04-fold (95% CI 1.02, 1.05) higher ESRD incidence associated with poverty status for Period 2 compared with the association between ESRD and poverty status in Period 1. Area-level poverty and its association with ESRD incidence is not static over time.

Comparative Effectiveness of Multifaceted Outreach to Initiate Colorectal Cancer Screening in Community Health Centers: A Randomized Controlled Trial.

INTRODUCTION: Colorectal cancer (CRC) screening rates are low among vulnerable populations. Fecal immunochemical tests (FITs) are one screening modality with few barriers. Studies have shown that outreach can improve CRC screening, but little is known about its effectiveness among individuals with no CRC screening history. We sought to determine whether outreach increases FIT uptake among patients with no CRC screening history compared to usual care. METHODS: This study was a patient-level randomized controlled trial, including 420 patients who had never completed CRC screening and were eligible for FIT; 66% were female, 62.1% were Latino, and 70.7% were uninsured. The main outcome measure was FIT completion within 6 months of the randomization date. We assessed FIT completion at different time points corresponding to receipt of outreach components. All analyses were re-run with 12-month data. RESULTS: Patients who received outreach were more likely to complete FIT than those in usual care (36.7% vs. 14.8%; p < 0.001). FIT completion was more common among patients with increased clinic visits. The difference in FIT completion between the outreach and usual care groups decreased over time. DISCUSSION: The intervention improved FIT uptake among patients with no CRC screening history. However, the intervention was less effective than in a previous trial targeting patients due for repeat screening. Additional research is needed to determine the best methods for improving CRC screening among this hard-to-reach group.