Smoking Increases Mortality Risk Among African Americans With Chronic Kidney Disease

Background: Smoking and chronic kidney disease (CKD) have a disproportionately high prevalence among African American (AA) adults, but their impact on mortality among AA adults is not well known. Methods: Given the lack of evidence in published literature on specific factors affecting the relationship between CKD and mortality among AA adults, we examined the influence of smoking on mortality among AA adults with CKD. National Health and Nutrition Examination Survey (NHANES, 1999-2010) data were analyzed with study participants prospectively followed up for mortality analysis through December 31, 2019, using National Death Index (NDI) death certificate records. Results: A total of 6,108 AA adults were included in the study sample, with more than two-fifths (44.9%) being smokers and 6.3% having CKD. AA individuals with CKD had 2.22 (95% CI = 1.38-3.57) times the risk of cardiovascular mortality, but when stratified by smoking, AA individuals with CKD who were current smokers had 3.21 times the risk of cardiovascular mortality. Similarly, in AA with CKD, the risk of all-cause mortality was 3.53 (95% CI = 1.31-9.47), but when stratified by smoking status, AA individuals with CKD who were current smokers had 5.54 times the risk of all-cause mortality. Conclusions: Smoking and CKD are highly prevalent in AA individuals and frequently cooccur, leading to higher rates of mortality. Smoking cessation interventions should be a priority in collaborative care models and interdisciplinary care teams for AA with CKD and current smoker status.