Mediators of the association between low socioeconomic status and chronic kidney disease in the United States.

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(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.

• Authors: Priya Vart, Ron T Gansevoort, Deidra C Crews, Sijmen A Reijneveld, Ute Bültmann
• Journal: American journal of epidemiology (Am J Epidemiol) Vol. 181 Issue 6 Pg. 385-96 (Mar 15 2015) ISSN: 1476-6256 [Electronic] United States
• PMID: 25731886 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © The Author 2015. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: [email protected].

Topics

• Adult
• Aged
• Ethnicity (statistics & numerical data)
• Female
• Health Behavior
• Health Services Accessibility
• Humans
• Income
• Male
• Middle Aged
• Nutrition Surveys
• Renal Insufficiency, Chronic (complications, epidemiology, psychology)
• Risk Factors
• Social Class
• United States (epidemiology)
• White People (statistics & numerical data)