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Abstract: SA-PO037

Population Impact of Social Determinants of Health on Premature Death Among US Adults with CKD

Session Information

Category: Diversity and Equity in Kidney Health

  • 900 Diversity and Equity in Kidney Health

Authors

  • Bundy, Joshua David, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Tian, Ling, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Kimbrough, Alexander D., Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Mills, Katherine T., Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Anderson, Amanda Hyre, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • He, Hua, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Theall, Katherine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
  • Chen, Jing, Tulane University School of Medicine, New Orleans, Louisiana, United States
  • He, Jiang, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States
Background

Social determinants of health (SDOH) are important underlying components of population health and are associated with adverse outcomes among patients with chronic kidney disease (CKD). However, the US population-level impact of SDOH on premature death among adults with CKD is unknown.

Methods

A nationally representative sample of individuals aged 20-74 from the US National Health and Nutrition Examination Survey (NHANES) 1999-2018 were included. We selected those with CKD defined as estimated glomerular filtrate rate <60 ml/min/1.73 m2 and/or urinary albumin-creatine ratio ≥30 mg/g. Self-reported SDOH were collected in each survey cycle (Figure). Deaths were ascertained from linkage to the National Death Index through 2019. Multivariable Cox proportional hazards regression and average population attributable fractions were used to investigate the contributions of SDOH to population-level premature all-cause mortality. All analyses accounted for the complex survey design.

Results

A total of 8422 individuals aged 20-74 years with CKD were included (11.0% weighted population prevalence). Mean survey-weighted age was 52.6 years and 55.3% were women. During a mean 8.6-year follow-up, 1252 deaths were recorded. After adjustment for age, sex, and race/ethnicity, all SDOH were significantly and independently associated with higher all-cause mortality and accounted for substantial portions of the US population mortality burden (Figure). Furthermore, dose-response associations were observed between the cumulative number of unfavorable SDOH and premature death, with having six or more unfavorable SDOH increasing mortality 6-fold.

Conclusion

SDOH were strongly and independently associated with premature death among US adults with CKD, and accounted for 50% of premature deaths in this population. Innovative structural policy interventions are urgently needed to prevent adverse events associated with SDOH among patients with CKD.

Funding

  • Other NIH Support