Prevalence of Self-Reported Kidney Disease in Older Adults by Sexual Orientation: Behavioral Risk Factor Surveillance System Analysis (2014–2019)

Abstract

Significance Statement Studies discusses CKD disparities by age, race and ethnicity, and socioeconomics. However, despite well-documented disparities in CKD risk factors in LGBT+ adults, limited literature addresses CKD prevalence in this population. This analysis uses Behavioral Risk Factor Surveillance System (2014–2019) data to compare self-reported kidney disease prevalence in LGBT+ older adults (older than 50 years) with their heterosexual peers. Our findings indicate that LGBT+ older adults have higher rates of self-reported kidney disease and a higher incidence of CKD risks including smoking, activity limitations, adverse health outcomes, and limited access to health care, housing, and employment. These results support increasing access to screening for CKD risk factors, providing culturally responsive health care, and addressing societal drivers of vulnerability in older LGBT+ adults. Background Existing research documents disparities in CKD by age, race and ethnicity, and access to health care. However, research on CKD in lesbian, gay, bisexual, and trans (LGBT+) older adults, despite their higher rates of diabetes, heart disease, smoking, and alcohol use, is limited. Methods Pooled data from the Behavioral Risk Factor Surveillance System (2014–2019) for 22,114 LGBT+ adults and 748,963 heterosexuals aged 50 and older were used to estimate the prevalence of self-reported kidney disease. Logistic regressions were used to compare older adults by sexual orientation. Results Older LGBT+ men (adjusted odds ratio=1.3; 95% confidence interval [CI], 1.09–1.54) were more likely than their heterosexual counterparts to report kidney disease, after controlling for sociodemographic factors, health behaviors, access to health care, and self-reported coronary heart disease, HIV, and diabetes; LGBT+ men and women also reported higher incidences of known risk factors for CKD. For example, both LGBT+ men (odds ratio [OR]=1.39; [95% CI], 1.26–1.54) and LGBT+ women (OR=1.39; [95% CI], 1.25–1.55) were more likely to be smokers and have a higher incidence of activity limitations, adverse health outcomes, and limited access to health care, housing, and employment. Conclusion These results support increasing access to screenings for CKD risk factors, providing preventative education and culturally responsive and affirming care, and addressing other societal drivers of vulnerability in older LGBT+ adults. The findings also support the value of interventions that address the interaction between CKD risk factors and the social marginalization that older LGBT+ adults experience.

Adding CKD to the Alphabet Soup: A Snapshot of Kidney Health in the LGBTQ+ Population

“…In this issue of JASN , Chandra and colleagues leveraged survey data from the 2014–2017 Behavioral Risk Factor Surveillance System (BRFSS) to compare the prevalence of self-reported kidney disease among adults aged 50 years and older who identified as LGBT+ ( N =22,114) versus straight/heterosexual ( N =748,963). 2 In the study, “LGBT+” referred to individuals who identified as “lesbian,” “gay,” “bisexual,” or “something else” across all gender identities, but did not include transgender and gender-expansive individuals who identified as straight. Self-reported kidney disease was defined as a “yes” response to the question “Not including kidney stones, bladder infection, or incontinence, were you ever told you had kidney disease?”…”

“…Using a series of logistic regression models taking into account sociodemographic factors, health behaviors, access to care, and key comorbidities (HIV, heart disease, and diabetes), the authors found that older LGBT+ men were still more likely than their heterosexual peers to report kidney disease (adjust odds ratio [OR], 1.3; 95% confidence interval [CI], 1.09 to 1.54), whereas the higher self-reported kidney disease prevalence was statistically attenuated among older LGBT+ women compared with older heterosexual women (adjusted OR, 1.16; 95% CI, 0.98 to 1.37). 2…”