Kidney Week

Abstract: FR-PO437

Neighborhood Socioeconomic Status and Incident ESRD

Session Information

• CKD: Risk Factors for Incidence and Progression - II
  November 03, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Chronic Kidney Disease (Non-Dialysis)

• 301 CKD: Risk Factors for Incidence and Progression

Authors

• Saunders, Milda Renne, University of Chicago, Chicago, Illinois, United States

Milda Renne Saunders,

• Cedillo-Couvert, Esteban A., University of Illinois at Chicago, Chicago, Illinois, United States

Esteban A. Cedillo-Couvert,

• Appel, Lawrence J., Johns Hopkins Medical Institutions, Baltimore, Maryland, United States

Lawrence J. Appel,

• He, Jiang, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States

Jiang He,

• Horwitz, Edward J., None, Solon, Ohio, United States

Edward J. Horwitz,

• Hsu, Jesse Yenchih, University of Pennsylvania, Philadelphia, Pennsylvania, United States

Jesse Yenchih Hsu,

• Daviglus, Martha L., University of Illinois at Chicago, Chicago, Illinois, United States

Martha L. Daviglus,

• Fischer, Michael J., University of Illinois Hospital and Health Sciences Center, Chicago, Illinois, United States

Michael J. Fischer,

• Ricardo, Ana C., University of Illinois at Chicago, Chicago, Illinois, United States

Ana C. Ricardo,

• Rincon-Choles, Hernan, Cleveland Clinic, Cleveland, Ohio, United States

Hernan Rincon-Choles,

• Steigerwalt, Susan P., University of Michigan, Ann Arbor, Michigan, United States

Susan P. Steigerwalt,

• Sha, Daohang, Uiversity of Pennsylvania, Philadelphia, Pennsylvania, United States

Daohang Sha,

• Sondheimer, James H., Wayne State University School of Medicine, Detroit, Michigan, United States

James H. Sondheimer,

• Lash, James P., University of Illinois at Chicago, Chicago, Illinois, United States

James P. Lash,

Group or Team Name

• On behalf of CRIC Investigators

Background

Although individuals with lower socioeconomic status (SES) are disproportionately affected by end-stage renal disease (ESRD), the association of neighborhood SES with incident ESRD has not been thoroughly evaluated. Using data from the Chronic Renal Insufficiency Cohort Study, we evaluated the relationship between neighborhood SES and ESRD.

Methods

Cox proportional hazards to examine the association between neighborhood SES quartiles and incident ESRD. We constructed a neighborhood-level SES summary measure using z scores for 6 census-derived variables using a validated approach.

Results

Among 3291 adults with CKD (mean eGFR 45 ml/min/1.73m², median proteinuria 0.19 g/24h), 41% were non-Hispanic white, 42% non-Hispanic black, 13% Hispanic. At study entry, compared to those in the highest quartile SES neighborhoods (Q4), individuals in lowest SES quartile neighborhoods (Q1) were more likely to be younger, female, non-Hispanic black or Hispanic, current smokers, have lower healthy eating scores and physical activity (p<0.001 for each). In addition, Q1 individuals had lower eGFR, higher proteinuria, and were more likely to have diabetes, hypertension, and cardiovascular disease; however, they were as likely as their Q4 counterparts to be on aspirin, statin, and ACE/ARB. During median follow-up of 6.8 years, there were 878 ESRD events. Multivariable analyses are summarized below.

Conclusion

While individuals in low SES neighborhoods had a greater burden of kidney disease risk factors and higher ESRD rates, likelihood of reaching ESRD was explained in part by individual SES.

a. Adjusted for center, age, sex, race/ethnicity b. Model 1 plus education, income, occupation c. Model 2 plus physical activity, diet, BMI, smoking, systolic BP, diabetes, eGFR, proteinuria, ACE/ARB, aspirin, statin

Funding

• NIDDK Support