Mediators of the Association between Low Socioeconomic Status and Chronic Kidney Disease in the United States.

Abstract

cycles of the National Health and Nutrition Examination Survey, we formally investigated potentially modifiable factors linking low socioeconomic status (SES) to chronic kidney disease (CKD) for their presence and magnitude of mediation. SES was defined using the poverty income ratio. The main outcome was CKD, defined as estimated glomerular filtration rate <60 mL/minute/ 1.73 m 2 (using the Chronic Kidney Disease Epidemiology Collaboration equation) and/or urinary albumin:creatinine ratio ≥30 mg/g. In mediation analyses, we tested the contributions of health-related behaviors (smoking, alcohol intake, diet, physical activity, and sedentary time), comorbid conditions (diabetes, hypertension, obesity, abdominal obesity, and hypercholesterolemia), and access to health care (health insurance and routine health-care visits) to this association. Except for sedentary time and diet, all examined health-related behaviors, comorbid conditions, and factors related to health-care access mediated the low SES-CKD association and contributed 20%, 32%, and 11%, respectively, to this association. In race/ethnicity-specific analyses, identified mediators tended to explain more of the association between low SES and CKD in non-Hispanic blacks than in other racial/ethnic groups. In conclusion, potentially modifiable factors like health-related behaviors, comorbid conditions, and health-care access contribute substantially to the association between low SES and CKD in the United States, especially among non-Hispanic blacks.

Area Deprivation and Risk of Death and CKD Progression: Long-Term Cohort Study in Patients under Unrestricted Nephrology Care

“…In particular, we showed an increased risk of neoplastic mortality in higher deprived patients. It is therefore reasonable to suggest a role for potential environmental exposure to toxic agents and/or lifestyle behaviours (e.g., poor diet and alcoholism) in patient who are most deprived, as reported in general population [15, 16].…”

“…In CKD, poor socio-economic status, including low annual household income, poor educational attainment, and neighbourhood deprivation, is associated with higher mortality and faster progression to end-stage kidney disease (ESKD) [1-14]. The greater cardiorenal risk in the disadvantaged people might be due to the clustering of comorbidities, unhealthy behaviours, and greater environmental exposures to toxins [15, 16].…”

“…On the other hand, whether nephrology management may attenuate the detrimental effect of deprivation on the prognosis of CKD patients remains similarly unexplored. Finally, the majority of studies assessing the role of ADI in the onset of CKD have been performed in the USA, where the substantial inequality might be related to the limited access to healthcare [11, 12, 15, 19, 20].…”

Giardiasis notifications are associated with socioeconomic status in Sydney, Australia: a spatial analysis

“…In the longer term, this may contribute to exacerbating already widening inequities, which is of concern in cities with existing geographic‐SES disparities such as Sydney 12 . Second, the existence of unreported giardiasis among disadvantaged communities may imply the presence of similar inequities in other more serious conditions such as cancer and heart disease, especially in their early detection, since the underlying health behaviours that drive the help‐seeking and diagnostic processes are similar 13–15 . For instance, an inability to access health services has been shown to lead to higher rates of comorbid conditions 13,16 .…”

“…Second, the existence of unreported giardiasis among disadvantaged communities may imply the presence of similar inequities in other more serious conditions such as cancer and heart disease, especially in their early detection, since the underlying health behaviours that drive the help‐seeking and diagnostic processes are similar 13–15 . For instance, an inability to access health services has been shown to lead to higher rates of comorbid conditions 13,16 . Finally, if there is an SES patterning to giardiasis reporting, it may systematically bias existing notifiable disease surveillance systems.…”