Abstract
BackgroundFinancial hardship is associated with poor health, however the association of financial hardship and incident diabetic kidney disease (DKD) is unknown. This study aimed to examine the longitudinal relationship between financial hardship and incident DKD among older adults with diabetes.MethodsAnalyses were conducted in 2735 adults age 50 or older with diabetes and no DKD using four waves of data (2006–2012) from the Health and Retirement Study, a national longitudinal cohort. The primary outcome was incident DKD. Financial hardship was based on three measures: 1) difficulty paying bills; 2) food insecurity; and 3) cost-related medication non-adherence using validated surveys. A dichotomous financial hardship variable (0 vs 1 or more) was constructed based on all three measures. Cox regression models were used to estimate the association between financial hardship, change in financial hardship experience and incident DKD adjusting for demographics, socioeconomic status, and comorbidities.ResultsDuring the median follow-up period of 4.1 years, incident DKD rate was higher in individuals with versus without financial hardship (41.2 versus 27/1000 person years). After adjustment, individuals with financial hardship (HR 1.32, 95% CI 1.04–1.68) had significantly increased likelihood of developing DKD compared to individuals without financial hardship. Persistent financial hardship (adjusted HR 1.52 95% CI 1.06–2.18) and negative financial hardship (adjusted HR 1.54 95% CI 1.02–2.33) were associated with incident DKD compared with no financial hardship experience. However, positive financial hardship was not statistically significant in unadjusted and adjusted (adjusted HR 0.89 95% CI 0.55–1.46) models. Cost-related medication non-adherence (adjusted HR 1.43 95% CI 1.07–1.93) was associated with incident DKD independent of other financial hardship measures.ConclusionsFinancial hardship experience is associated with a higher likelihood of incident DKD in older adults with diabetes. Future studies investigating factors that explain the relationship between financial hardship and incident DKD are needed.
Highlights
Diabetes affects about 30.3 million people in the United States [1] and about 451 million people worldwide [2]
Longitudinal relationship between financial hardship and patient reported incident diabetic kidney disease (DKD) Incident DKD rate per 1000 person years of followup was higher in individuals with financial hardship (41.2 per 1000 person years) compared with individuals without financial hardship experience (27 per 1000 person years), see Fig. 1 and Table 2
Univariate and multivariate-adjusted Hazard Ratio (HR) of incident DKD was higher for people with financial hardship compared with people without financial hardship
Summary
Diabetes affects about 30.3 million people in the United States [1] and about 451 million people worldwide [2]. Social determinants of health are the conditions in which individuals are born, grow, live, work, and age [11]. Financial hardship is a measure that accounts for material conditions [15], psychological response [16, 17], and coping behaviors [18] related to interaction with the healthcare system [19, 20]. It considers the lack of available funds or resources with downstream effects [21], providing a more thorough depiction of experiences tied to socioeconomic status. This study aimed to examine the longitudinal relationship between financial hardship and incident DKD among older adults with diabetes
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