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Using publicly available data to describe multi-contamination and explore the link with end-stage renal disease
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Edité par CCSD -
International audience. End-stage renal disease (ESRD) is the final stage of chronic kidney disease, when renal function is highly impaired leading to the need of a long-term dialysis or a kidney transplant. Etiology of ESRD remains partly unknown and in particular the role of the environment. The objective of the present work is precisely to identify new etiological hypothesis related to the environment. Since 2005, in Northern France, newly detected ESRD cases are recorded in a health register called Nephronor. On this basis, standardized incidence ratios were calculated at the municipal level after being adjusted for several confounding factors, including : age, sex, social deprivation, distance to dialysis centers and glomerular filtration rate. Using spatial statistics, heterogeneity in ESRD incidence was studied and atypical spatial clusters were detected.In parallel, a complete environmental database was built using publicly available data. After an exhaustive inventory of existing data, the most appropriate databases were selected and a long data management process was achieved. Finally, more than one hundred variables were included and allocated in one of the six following dimensions : Contamination levels (air, water, soils), Emission levels, Source locations, Land use, Agricultural practices and Climate. For each dimension, a composite indicator was built at the municipal level. Each of these composite indicators were used to test etiological hypothesis, by comparing high-incidence with low-incidence ESRD spatial clusters. With this territorial approach, the ambition is not to demonstrate causal effects but rather to identify hypothesis that could be tested at the individual level in future epidemiological studies.
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