Low Birth Weights Contribute to the High Rates of Early-Onset Chronic Renal Failure in the Southeastern United States

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Abstract
FOR THE past 60 years, the southeastern region of the United States and South Carolina in particular have had such unusually high death rates from stroke that this region is known as the "stroke belt."1,2 The excessive disease risks are particularly evident with high incidence rates for young black adults.3 More recently, it has also become apparent that an unusually large number of people in South Carolina have chronic renal failure (end-stage renal disease [ESRD]) and require dialysis.4 The age-, race-, and sex-standardized incidence of ESRD in the state is 345 per million compared with an overall rate of 268 per million in the United States.4 The incidence of ESRD in South Carolina doubled from 1987 to 1996.4 While renal failure is considered a late complication of chronic diseases, such as diabetes and hypertension,5,6 40% of patients with ESRD are under age 55 years in South Carolina.7 Similarly high rates and trends are seen in the neighboring states in the southeastern United States.4,7 The disease burden is particularly great for blacks. The black population of the United States has 5-fold higher rates of ESRD than the white population, even after adjusting for differences in socioeconomic status.6-9 Blacks account for approximately 30% of the South Carolina population but for 69% of the ESRD cases.7