Income linked to access disparities among patients with CKD in a universal health system
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Key takeaways:
- In a universal health system, income can play a role in a patient’s access to kidney care.
- Regions with higher area deprivation also showed a higher prevalence of chronic health conditions.
Patients with chronic kidney disease may have difficulty accessing equitable treatment even in a country with universal health care, according to published findings.
“Although previous studies have shown the association between socioeconomic status and CKD, little is known about whether this association exists in countries such as Japan where universal health coverage has been mostly achieved,” Nana Ishimura, MD, of the department of social epidemiology, Graduate School of Medicine, Kyoto University, and colleagues wrote. “We wanted to identify any association of income-based disparity with development of impaired kidney function among the working population of Japan.”
Data derived from Ishimura N, et al. JAMA Health Forum.2024;doi:10.1001/jamahealthforum.2023.5445.
In a retrospective cohort study, researchers identified 17,990,680 people aged 35 to 74 years who were enrollees in the Japan Health Insurance Association from April 1, 2015, to March 31, 2016. The insurance plan covers approximately 40% of the working-age population in Japan – about 30 million enrollees, according to the study.
From that group of enrollees, researchers selected 5.6 million people who were not on dialysis and had eGFR measured at least twice from 2015 to 2022. Mean age in the study group was 49 years; 33.4% were women. The study was conducted from Sept. 1, 2021, to March 31, 2023.
Income levels in the study group, collected from insurance premium information, ranged from $5,032 per year to $120,590 per year. “Females constituted 71.1% of the lowest income group, and males constituted 90.7% of the highest income group,” the researchers wrote.
“After adjusting for potential confounders, the lowest income decile (lowest 10th percentile) demonstrated a greater risk of rapid CKD progression (adjusted odds ratio,
1.70; 95% CI, 1.67-1.73) and a greater risk of kidney replacement therapy initiation (adjusted hazard ratio, 1.65; 95% CI, 1.47-1.86) compared with the highest income decile (top 10th percentile),” the researchers wrote. “A negative monotonic association was more pronounced among males and individuals without diabetes and was observed in individuals with early (CKD stage 1-2) and advanced (CKD stage 3-5) disease.”
Decline in eGFR was largest in the lowest income group and smallest in the highest income group.
Findings of the study show “economic guarantees for medical care and secondary prevention opportunities may be insufficient for preventing the onset and progression of CKD,” the researchers wrote. “Although the strong association we observed between low income and the development of impaired kidney function does not necessarily imply causality, further society-wide interventions to reduce poverty, poverty-related social stress and social-behavioral risks need to be considered ... there is a need to focus on socioeconomically disadvantaged populations,” the researchers wrote.
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