Adults with kidney disease in lower-skilled households may have worse mortality
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Key takeaways:
- Adults with early kidney disease in unskilled or unemployed households had increased mortality.
- Illness, mental health and other factors were reported by those households.
Adults with early kidney disease who live in unemployed or lower-skilled households may have higher mortality rates compared with those in professional households, according to published data.
“People in deprived communities develop kidney disease earlier, experience less proactive care, progress more rapidly toward kidney failure and die younger,” Simon Sawhney, MBChB, BScMedSci, MRCP, PhD, of the U.K.-based University of Aberdeen Center for Health Data Science, wrote with colleagues. “While literature on the equity of access to kidney care has focused on the most advanced stages of kidney disease, there is increasing recognition of the importance of early kidney care.”
As part of the North of Scotland, Grampian area (GLOMMS-CORE) study, researchers sought to assess the impact of individual- and neighborhood-level social and deprivation factors on kidney health outcomes.
The study evaluated health records and individual census records of adults in the Grampian region in the U.K. The analysis involved four parallel cohorts with incident kidney presentations based on 2011 to 2021 population laboratory results.
In each group, adults were included from the date they had lab test beyond one of the four following severity thresholds: eGFR lower than 60 mL/min/1.73 m2 (mild/early), 45 mL/min/1.73 m2 (moderate), 30 mL/min/1.73 m2 (advanced) and acute kidney disease.
Researchers compared household and neighborhood socioeconomic measures, living circumstances and long-term mortality between each group.
Household socioeconomic position and neighborhood classifications were complex and did not often align, according to Sawhney and colleagues. Patients with early kidney disease in unskilled or unemployed households had increased mortality rates vs. those in professional households. Data showed adjusted HRs of 1.26 and 1.77 increased risk of mortality for those in unskilled and unemployed households, respectively.
Adults in “deprived” households or areas had greater mortality rates, and patients in both categories had the worst outcomes at large, the researchers found. Factors like illness, poor mental health, living alone, lack of car ownership, language difficulties and sensory impairments were frequently reported by unskilled and unemployed households.
“Moreover, even in the early stages of kidney disease, individuals reported deteriorating health and well-being, physical disabilities adverse mental health, isolation, lack of access to transport, and difficulties relating to language and communication,” the researchers wrote. “These challenges may all affect their ability to attain good kidney health, health care and live well.”
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