Insights into Geographic Patterns, Urban-Rural Contrasts, and Health Care Disparities in Glomerular Disease Incidence in a Canadian Province
Bibliographic record
Abstract
Rationale & Objective Glomerular diseases (GDs) are a group of immune-mediated or genetic diseases that involve the filtering units of the kidneys, or glomeruli. Using centralized provincial kidney pathology records and census data, we aimed to examine the incidence and temporal trend of GDs in Saskatchewan, Canada and understand rural/urban differences in GD distribution. Study Design Population-based epidemiologic study. Setting & Participants All adult patients who underwent kidney biopsies in Saskatchewan, Canada, from 2002-2018. Exposures or Predictors Biopsy diagnosis, 3-digit postal codes, laboratory parameters, dialysis initiation dates, and mortality data. Outcomes Incidence of primary GD, dialysis initiation, and all-cause mortality. Analytical Approach Regional variations in GD were analyzed using SaTScan v10.1.3 software. Incidence trends, rural/urban differences, and geospatial clustering were evaluated. Ethics approval was obtained from the provincial research and ethics board. Results A total of 1,372 of 3,509 kidney biopsies met the inclusion criteria. GD incidence increased from 4.6 to 13.6 per 100,000 persons from 2002 to 2018 ( P < 0.001). GD incidence was higher in rural areas than in urban areas (10.73 vs 8.92 per 100,000 per year, P < 0.001). Significantly higher dialysis progression rates were seen for rural and remote areas ( P < 0.001). A geospatial cluster of 345.7 km 2 was identified for lupus nephropathy, with an incidence rate ratio of 1.73, a relative risk of 2.7, and a log likelihood ratio of 13.87. Limitations Biopsies were dependent on the threshold of the ordering physician. Likely, frail and elderly patients and patients with early onset glomerulonephritis, late presentations, and higher bleeding risk were not biopsied, which led to an underrepresentation of these groups. Conclusions The incidence and relative burden of GDs have increased over time in Saskatchewan, with notable rural/urban differences. We identified a geographic cluster for lupus nephropathy encompassing rural and urban areas. Patients in rural and remote areas had higher dialysis transition rates, and mortality rates were relatively higher in urban areas. Addressing and understanding the multifaceted factors driving these disparities are essential steps toward easing the burden of GDs on impacted communities. Plain-Language Summary Glomerular diseases are a group of immune-mediated or genetic diseases that involve the glomeruli, the filtering units of the kidneys. We conducted a population-level study based on 1,372 kidney biopsies performed on adults from 2002-2018 in Saskatchewan, Canada. We collected and analyzed data on age, sex, 3-digit postal codes, date of biopsy, glomerular disease diagnosis, dialysis start date, and death. The incidence of glomerular diseases increased from 4.6 to 13.6 per 100,000 persons over the study period, with higher rates in rural areas. Patients in rural and remote areas also had higher rates of dialysis progression, whereas mortality rates were higher in urban areas. A geospatial cluster was identified for lupus nephropathy encompassing both rural and urban areas. This study highlights understanding and addressing the factors behind these differences.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.005 | 0.010 |
| Science and technology studies | 0.004 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".