TY - JOUR
T1 - Individual and neighborhood socioeconomic status and progressive chronic kidney disease in an elderly population
T2 - The Cardiovascular Health Study
AU - Merkin, Sharon Stein
AU - Diez Roux, Ana V.
AU - Coresh, Josef
AU - Fried, Linda F.
AU - Jackson, Sharon A.
AU - Powe, Neil R.
N1 - Funding Information:
This manuscript was prepared using a limited access dataset obtained from the National Heart, Lung, and Blood Institute. This research was supported in part by mini-Grant 875–2151 from the National Kidney Foundation of Maryland, (Dr. Merkin); Grant no. K24 DK02643 from the National Institute of Diabetes, Digestion and Kidney Diseases, Bethesda, MD (Dr. Powe); and Grant no. MD00206 P60 from the National Center on Minority Health and Health Disparities, The National Institutes of Health (Dr. Diez Roux).
PY - 2007/8
Y1 - 2007/8
N2 - Few studies have focused on the association between socioeconomic status (SES) and progressive chronic kidney disease (pCKD) in an elderly population. We conducted a cohort study of 4735 Cardiovascular Health Study participants, ages 65 and older and living in 4 US communities, to examine the independent risk of pCKD associated with income, education and living in a low SES area. pCKD was defined as creatinine elevation ≥0.4 mg/dL (35 μmol/L) over a 4-7 year follow-up or CKD hospitalization. Area SES was characterized using measures of income, wealth, education and occupation for 1990 (corresponding to time of enrollment) US Census block groups of residence. Age and study site-adjusted incidence rates (per 1000 person years) of pCKD by quartiles of area-level SES score, income and education showed decreasing rates with increasing SES. Cox proportional hazards models showed that living in the lowest SES area quartile, as opposed to the highest, was associated with 50% greater risk of pCKD, after adjusting for age, gender, study site, baseline creatinine, and individual-level SES. This increased risk and trend persisted after adjusting for lifestyle risk factors, diabetes and hypertension. We found no significant independent associations between pCKD and individual-level income or education (after adjusting for all other SES factors). As such, living in a low SES area is associated with greater risk of pCKD in an elderly US population.
AB - Few studies have focused on the association between socioeconomic status (SES) and progressive chronic kidney disease (pCKD) in an elderly population. We conducted a cohort study of 4735 Cardiovascular Health Study participants, ages 65 and older and living in 4 US communities, to examine the independent risk of pCKD associated with income, education and living in a low SES area. pCKD was defined as creatinine elevation ≥0.4 mg/dL (35 μmol/L) over a 4-7 year follow-up or CKD hospitalization. Area SES was characterized using measures of income, wealth, education and occupation for 1990 (corresponding to time of enrollment) US Census block groups of residence. Age and study site-adjusted incidence rates (per 1000 person years) of pCKD by quartiles of area-level SES score, income and education showed decreasing rates with increasing SES. Cox proportional hazards models showed that living in the lowest SES area quartile, as opposed to the highest, was associated with 50% greater risk of pCKD, after adjusting for age, gender, study site, baseline creatinine, and individual-level SES. This increased risk and trend persisted after adjusting for lifestyle risk factors, diabetes and hypertension. We found no significant independent associations between pCKD and individual-level income or education (after adjusting for all other SES factors). As such, living in a low SES area is associated with greater risk of pCKD in an elderly US population.
KW - Elderly
KW - Kidney disease
KW - Neighborhood
KW - Socioeconomic
KW - USA
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U2 - 10.1016/j.socscimed.2007.04.011
DO - 10.1016/j.socscimed.2007.04.011
M3 - Article
C2 - 17499411
AN - SCOPUS:34447517039
SN - 0277-9536
VL - 65
SP - 809
EP - 821
JO - Social Science and Medicine
JF - Social Science and Medicine
IS - 4
ER -