Impact of socioeconomic status on the quality of life of ESRD patients

Abstract

Background: Socioeconomic status (SES) has been associated with the incidence of end-stage renal disease (ESRD); however, the impact of SES on the quality of life (QOL) of these patients has not been clearly defined. Methods: One hundred eighteen patients were prospectively evaluated at the beginning of dialysis treatment and reassessed (n = 90) after an average of 7 months. QOL was measured by means of the Medical Outcomes Survey 36-Item Short Form (SF-36). Classification of SES was according to validated criteria of the Brazilian Association of Research Institutes. Results: Mean scores for SF-36 dimensions were decreased in patients with low compared with high SES, with greater differences noted during follow-up. At this time, mean scores for SF-36 scales for the low- and high-SES groups were as follows: Functional Capacity, 43 ± 31 versus 68 ± 26 (P < 0.01); Physical Aspect, 34 ± 36 versus 56 ± 38; Pain, 55 ± 31 versus 80 ± 28 (P < 0.01); General Health Status, 60 ± 21 versus 67 ± 19; Vitality, 42 ± 25 versus 59 ± 16 (P < 0.05); Social Aspect, 53 ± 32 versus 81 ± 21 (P < 0.01); Emotional Aspect, 49 ± 44 versus 70 ± 41; and Mental Health, 51 ± 27 versus 70 ± 22 (P < 0.05), respectively. These differences were more pronounced than expected for an age- and sex-matched sample of the Brazilian general population. Multivariate analysis showed that SES continued to significantly affect all QOL dimensions, explaining 5.5% to 14.1% of variation in scales. Conclusion: SES is an important factor associated with QOL in patients with ESRD. Further studies to determine optimum interventions and measures in groups with lower SES may be important to improve QOL outcomes and reduce their morbidity. Am J Kidney Dis 41:186-195. © 2003 by the National Kidney Foundation, Inc.