US–Mexico Border Counties Face Growing Chronic Kidney Disease Disparities and Workforce Shortages

New research indicates that U.S.–Mexico border counties experience disproportionately elevated rates of death from chronic kidney disease alongside reduced availability of nephrologists. The findings are scheduled to be presented at the American Society of Nephrology Kidney Week meeting.

Investigating Mortality Trends Over Two Decades

When investigators analyzed data sourced from the U.S. Centers for Disease Control and Prevention covering the years from 1999 to 2022, they uncovered widening geographic gaps in chronic kidney disease mortality. Along the U.S.–Mexico border, chronic kidney disease-related mortality increased from 48.2 to 81.4 deaths per 100,000 population. This represented an approximate rise of 2.7 percent per year.

By comparison, mortality rates in nonborder counties increased from 35.1 to 54.4 deaths per 100,000 over the same timeframe. This growth pattern translated to approximately 1.3 percent per year, which is roughly half the annual pace observed along the border region.

The Role of Nephrology Workforce Availability

The investigation also evaluated the relationship between specialist availability and patient outcomes. Researchers found a consistent association between nephrology workforce distribution and chronic kidney disease-related mortality.

• Counties featuring the lowest nephrologist density demonstrated substantially higher mortality figures than those possessing the greatest workforce availability, recording 91.4 versus 52.8 deaths per 100,000 population.
• Each decrease of one nephrologist per 100,000 population correlated with approximately 7 percent higher chronic kidney disease-related mortality.
• This calculation accounted for adjustments addressing diabetes, obesity, poverty, uninsured status, rurality, hospital access, and demographic variables.

Context and Study Limitations

Corresponding author Sofia Yamada of the University of Texas Rio Grande Valley School of Medicine noted that the border region is confronting a rising kidney health disparity that parallels major geographic differences in specialized care access. Yamada emphasized that many border counties are predominantly Hispanic and medically underserved.

However, study authors acknowledged important limitations. Because the investigation relied on a county-level ecological analysis design, it cannot establish direct causation between workforce shortages and elevated mortality. Nevertheless, researchers suggest that the persistent association highlights critical questions regarding how the geographic distribution of specialists impacts health equity in medically vulnerable populations.