Poverty, Race, and CKD in a Racially and Socioeconomically Diverse Urban Population

Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
American Journal of Kidney Diseases (Impact Factor: 5.9). 03/2010; 55(6):992-1000. DOI: 10.1053/j.ajkd.2009.12.032
Source: PubMed


Low socioeconomic status (SES) and African American race are both independently associated with end-stage renal disease and progressive chronic kidney disease (CKD). However, despite their frequent co-occurrence, the effect of low SES independent of race has not been well studied in CKD.
Cross-sectional study.
2,375 community-dwelling adults aged 30-64 years residing within 12 neighborhoods selected for both socioeconomic and racial diversity in Baltimore City, MD.
Low SES (self-reported household income <125% of 2004 Department of Health and Human Services guideline), higher SES (> or =125% of guideline); white and African American race.
CKD defined as estimated glomerular filtration rate <60 mL/min/1.73 m(2). Logistic regression used to calculate ORs for relationship between poverty and CKD, stratified by race.
Of 2,375 participants, 955 were white (347 low SES and 608 higher SES) and 1,420 were African American (713 low SES and 707 higher SES). 146 (6.2%) participants had CKD. Overall, race was not associated with CKD (OR, 1.05; 95% CI, 0.57-1.96); however, African Americans had a much greater odds of advanced CKD (estimated glomerular filtration rate <30 mL/min/1.73 m(2)). Low SES was independently associated with 59% greater odds of CKD after adjustment for demographics, insurance status, and comorbid disease (OR, 1.59; 95% CI, 1.27-1.99). However, stratified by race, low SES was associated with CKD in African Americans (OR, 1.91; 95% CI, 1.54-2.38), but not whites (OR, 0.95; 95% CI, 0.58-1.55; P for interaction = 0.003).
Cross-sectional design; findings may not be generalizable to non-urban populations.
Low SES has a profound relationship with CKD in African Americans, but not whites, in an urban population of adults, and its role in the racial disparities seen in CKD is worthy of further investigation.

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    • "However, factors related with QoL in patients with CKD vary between studies and countries. Race, sex, co-morbidities, haematocrit level, educational and socioeconomic status are the most common among these factors (Valderrabano et al. 2001; Sesso et al. 2003; Crews et al. 2010). In Greece a number of studies have explored QoL and possible relevant factors in dialysis and transplantation patients (Kontodimopoulos et al. 2009; Theofilou 2012), but none in the CKD population to date. "
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    ABSTRACT: Quality of Life (QoL) is often poor in people undergoing dialysis and this sometimes contributes to the high rate of morbidity and mortality. The aim of our study is to assess the QoL of patients on haemodialysis in Greece and discuss the socio-demographic factors that affect QoL in this period of financial crisis. Patients with CKD not on dialysis, plus those undergoing Haemodialysis (HD) and Peritoneal Dialysis (PD) were invited to complete the SF-36 questionnaire electronically, supervised by a trained nurse. Patients were asked about their marital status, education level and monthly household income. Additionally, patients were requested to comment on their subjective financial difficulties. A total of 172 patients were enrolled in the study, 39 of them were undergoing PD, 90 on HD and 43 had CKD. Among those with CKD, on HD and PD, 9.3%, 17.8% and 23.1%, respectively, had 'some/a lot' difficulties in copying with financial problems. The physical component summary score was significant lower in HD, while the summary score of the mental component showed no differences between the groups. In multiple linear regression analysis, age and dialysis had significantly negative correlations with physical functioning scores. Those who were divorced or widowed tended to perform worse in physical scores compared with those who were married. Mental scores were affected only by coping with financial difficulties. In general terms, people with CKD patients present with a poor QoL. Apart from the burden of the renal disease per se, social and economic factors (divorce, financial difficulties) seem to aggravate their status, especially in this period of financial crisis. © 2015 European Dialysis and Transplant Nurses Association/European Renal Care Association.
    Full-text · Article · Jun 2015 · Journal of Renal Care
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    • "Previous studies have noted a particularly detrimental effect of low income on blacks with regards to CKD prevalence and severity. Lower income was associated with increased odds of CKD among blacks but not whites in an urban population [18] and lower income was associated with higher albuminuria in a study of REGARDS participants [4]. In line with a previous study noting higher mortality among blacks with pre-dialysis CKD [11], we found the same after adjustment for important confounders. "
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    ABSTRACT: Background Socioeconomic status (SES) is independently associated with chronic kidney disease (CKD) progression; however, its association with other CKD outcomes is unclear. In particular, the potential differential effect of SES on mortality among blacks and whites is understudied in CKD. We aimed to examine survival among individuals with prevalent CKD by income and race in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Methods We examined 2,761 participants with prevalent CKD stage 3 or 4 between 2003 and 2007 in the REGARDS cohort. Participants were followed through March 2013. Mortality from any cause was assessed by income and race (black or white). Low income was defined as an annual household income < $20,000, and was compared to higher incomes (≥$20,000). Cox proportional hazards models adjusted for age, gender, education, insurance, CKD stage, comorbidity and county-level poverty were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Results A total of 750 deaths (27.5%) occurred during the follow-up period. Average follow-up time was 6.6 years among those alive and 3.7 years among those who died. Low income participants had an elevated adjusted hazard of mortality (HR = 1.58, 95% CI 1.24-2.00) compared to higher income participants. Low income was associated with all-cause mortality regardless of race (HR 1.53; 95% CI 1.18-1.99 among blacks and HR 1.38; 95% CI 1.10-1.74 among whites), with no significant statistical interaction between household income and race (p-value = 0.634). However, black participants had a higher adjusted hazard of mortality (HR = 1.30, 95% CI 1.02-1.65) compared to whites, which was independent of income. Conclusion Income was associated with increased mortality for both blacks and whites with CKD. Blacks with CKD had higher mortality than whites even after adjusting for important socio-demographic and clinical factors.
    Full-text · Article · Aug 2014 · BMC Nephrology

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