Socioeconomic Status and Chronic Kidney Disease in the US
Using data collected from 9,823 participants in the 2007–2008 and 2009–2010 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 (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.
Chronic kidney disease (CKD) is a major public health problem. CKD is associated with a number of adverse health outcomes, including end-stage renal disease, cardiovascular mortality, and all-cause mortality, and its burden is increasing. In the United States, the prevalence of CKD is estimated to be 15%, and lifetime risk of developing CKD is nearly 60%. However, the burden of CKD is not equally distributed among populations. Substantial inequality is observed in incidence and prevalence of CKD across socioeconomic and racial/ethnic groups.
Socioeconomic status (SES) is a major contributor to inequalities in CKD prevalence, and its effects are potentially modifiable. The US national blueprint for public health goals as per Healthy People 2020 (http://www.healthypeople.gov/) explicitly aims for the elimination of socioeconomic health disparities related to kidney disease in the United States by 2020. To reach this aim, the identification of factors linking SES to CKD is pivotal. Adverse health-related behaviors, comorbid conditions, and limited access to health care have been suggested as potential mediators that link low SES to CKD. However, to our knowledge, no previous study has formally tested for mediation or estimated the extent to which mediators contribute to socioeconomic disparities in CKD. Consequently, evidence is largely lacking on mediators actually linking SES to CKD and on the extent to which correction for these mediators could mitigate socioeconomic disparities in CKD.
Therefore, we sought to 1) identify mediators (health-related behaviors, comorbid conditions, and health-care access) linking SES and CKD in a US population and 2) determine the extent to which identified mediators contribute to the association between low SES and CKD in the United States.
Abstract and Introduction
Abstract
Using data collected from 9,823 participants in the 2007–2008 and 2009–2010 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 (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.
Introduction
Chronic kidney disease (CKD) is a major public health problem. CKD is associated with a number of adverse health outcomes, including end-stage renal disease, cardiovascular mortality, and all-cause mortality, and its burden is increasing. In the United States, the prevalence of CKD is estimated to be 15%, and lifetime risk of developing CKD is nearly 60%. However, the burden of CKD is not equally distributed among populations. Substantial inequality is observed in incidence and prevalence of CKD across socioeconomic and racial/ethnic groups.
Socioeconomic status (SES) is a major contributor to inequalities in CKD prevalence, and its effects are potentially modifiable. The US national blueprint for public health goals as per Healthy People 2020 (http://www.healthypeople.gov/) explicitly aims for the elimination of socioeconomic health disparities related to kidney disease in the United States by 2020. To reach this aim, the identification of factors linking SES to CKD is pivotal. Adverse health-related behaviors, comorbid conditions, and limited access to health care have been suggested as potential mediators that link low SES to CKD. However, to our knowledge, no previous study has formally tested for mediation or estimated the extent to which mediators contribute to socioeconomic disparities in CKD. Consequently, evidence is largely lacking on mediators actually linking SES to CKD and on the extent to which correction for these mediators could mitigate socioeconomic disparities in CKD.
Therefore, we sought to 1) identify mediators (health-related behaviors, comorbid conditions, and health-care access) linking SES and CKD in a US population and 2) determine the extent to which identified mediators contribute to the association between low SES and CKD in the United States.
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