Abstract
BackgroundA growing body of evidence supports the potential role of social determinants of health on health outcomes. However, few studies have examined the cumulative effect of social determinants of health on health outcomes in adults with chronic kidney disease (CKD) with or without diabetes. This study examined the cumulative impact of social determinants of health on mortality in U.S. adults with CKD and diabetes.MethodsWe analyzed data from National Health and Nutrition Examination Surveys (2005–2014) for 1376 adults age 20 and older (representing 7,579,967 U.S. adults) with CKD and diabetes. The primary outcome was all-cause mortality. CKD was based on estimated glomerular filtration rate and albuminuria. Diabetes was based on self-report or Hemoglobin A1c of ≥6.5%. Social determinants of health measures included family income to poverty ratio level, depression based on PHQ-9 score and food insecurity based on Food Security Survey Module. A dichotomous social determinant measure (absence vs presence of ≥1 adverse social determinants) and a cumulative social determinant score ranging from 0 to 3 was constructed based on all three measures. Cox proportional models were used to estimate the association between social determinants of health factors and mortality while controlling for covariates.ResultsCumulative and dichotomous social determinants of health score were significantly associated with mortality after adjusting for demographics, lifestyle variables, glycemic control and comorbidities (HR = 1.41, 95%CI 1.18–1.68 and HR = 1.41, 95%CI 1.08–1.84, respectively). When investigating social determinants of health variables separately, after adjusting for covariates, depression (HR = 1.52, 95%CI 1.10–1.83) was significantly and independently associated with mortality, however, poverty and food insecurity were not statistically significant.ConclusionsSpecific social determinants of health factors such as depression increase mortality in adults with chronic kidney disease and diabetes. Our findings suggest that interventions are needed to address adverse determinants of health in this population.
Highlights
Chronic kidney disease (CKD) is a heterogeneous group of disorders characterized by alterations in kidney structure and function, which manifest as decreased glomerular filtration rate < 60 ml/min/1.73m2 or presence of urinary albumin excretion of ≥30 mg/day for at least 3 months [1]
After adjusting for demographics, the hazard ratio became significant at 1.41 (95%Confidence Interval (CI) 1.18, 1.67). This remained significant after adding lifestyle variables, glycemic control and comorbidities with hazard ratio of 1.41 (95%CI 1.18, 1.68), for every 1 score increase in the cumulative social determinant scale
In a national sample of adults with chronic kidney disease (CKD) and diabetes we found that social determinants of health are significantly associated with mortality
Summary
Chronic kidney disease (CKD) is a heterogeneous group of disorders characterized by alterations in kidney structure and function, which manifest as decreased glomerular filtration rate < 60 ml/min/1.73m2 or presence of urinary albumin excretion of ≥30 mg/day for at least 3 months [1]. Social determinants are often categorized into four groups of interacting factors: 1) socioeconomic circumstances, 2) psychosocial factors, 3) neighborhood environment, and 4) political, economic and cultural drivers [10, 11]. These include factors such as food insecurity, housing instability, social support, and violence in one’s community [11, 12]. A growing body of evidence supports the potential role of social determinants of health on health outcomes. Few studies have examined the cumulative effect of social determinants of health on health outcomes in adults with chronic kidney disease (CKD) with or without diabetes. This study examined the cumulative impact of social determinants of health on mortality in U.S adults with CKD and diabetes
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