Neighborhood Socioeconomic Status and Cardiovascular Events in Adults With CKD: The CRIC Study

IF 3.2 Q1 UROLOGY & NEPHROLOGY
Avi G. Aronov , Milda R. Saunders , Jesse Y. Hsu , Daohang Sha , Martha Daviglus , Michael J. Fischer , Lawrence J. Appel , James Sondheimer , Jiang He , Hernan Rincon-Choles , Edward J. Horwitz , Tanika N. Kelly , Ana C. Ricardo , James P. Lash
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Abstract

Rationale & Objective

In the general population, neighborhood socioeconomic status (SES) has been found to be associated with cardiovascular risk, but this relationship has not been well studied among patients with chronic kidney disease (CKD). This study seeked to evaluate the association between neighborhood SES and cardiovascular outcomes in a CKD cohort.

Study Design

Multicenter prospective cohort.

Setting & Participants

In total, 3,197 participants in the Chronic Renal Insufficiency Cohort Study without cardiovascular disease at baseline.

Exposure

Neighborhood SES quartiles using a validated neighborhood-level SES summary measure for 6 census-derived variables.

Outcome

Incident heart failure, myocardial infarction, and all-cause death.

Analytical Approach

Cox proportional hazards.

Results

During median follow-up of 8.8 years, there were 465 incident heart failure events, 297 myocardial infarctions, and 891 deaths. In a fully adjusted model, among individuals with estimated glomerular filtration rate ≥45 mL/min/1.73 m2, lowest neighborhood SES quartile was associated with higher risk of heart failure (HR, 1.96 [95% CI, 1.04-3.67]) compared with the highest quartile. This association was not significant among those with estimated glomerular filtration rate <45 mL/min/1.73 m2 (P for interaction < 0.1). There was no association between neighborhood SES and myocardial infarction; however, in the same multivariable-adjusted model, less than high school education was associated with higher risk of myocardial infarction (HR, 1.52 [95% CI, 1.06-2.17]). Among those aged greater than 60 years, there was a significant association between the lowest neighborhood SES quartile and death (HR, 1.72 [95% CI, 1.06-2.78]), but this association was not significant among those aged 60 years and younger (P for interaction < 0.05).

Limitations

Findings are subject to residual confounding and bias.

Conclusions

In a CKD cohort, neighborhood-level SES was associated with incident heart failure among individuals with more preserved kidney function and death in those younger than 60 years. Policies and public health and health system interventions are needed to address individual- and neighborhood-level SES factors to improve outcomes for patients with CKD residing in disadvantaged communities.

Plain-Language Summary

Because patients with chronic kidney disease (CKD) experience high rates of cardiovascular complications, we evaluated the relationship between neighborhood-level socioeconomic status (SES) and cardiovascular outcomes using data from the Chronic Renal Insufficiency Cohort Study. We found that residing in disadvantaged neighborhoods was associated with a higher risk of heart failure in those with milder CKD and a higher risk of death in those who were aged less than 60 years. These findings highlight the need for public health and health system interventions to address these disparities.
社区社会经济状况与慢性肾脏病成人心血管事件:CRIC 研究
理论依据& 目标在普通人群中,邻里社会经济地位(SES)被发现与心血管风险有关,但在慢性肾脏病(CKD)患者中,这种关系还没有得到很好的研究。本研究旨在评估 CKD 队列中邻里社会经济地位与心血管预后之间的关系。研究设计多中心前瞻性队列。结果在中位随访 8.8 年期间,共发生 465 例心衰、297 例心肌梗死和 891 例死亡。在完全调整模型中,在估计肾小球滤过率≥45 mL/min/1.73 m2的个体中,与最高四分位数相比,邻近地区社会经济地位最低的四分位数与较高的心衰风险相关(HR,1.96 [95% CI,1.04-3.67])。在估计肾小球滤过率为 45 mL/min/1.73 m2 的人群中,这种关联并不显著(交互作用 P 为 0.1)。邻里社会经济地位与心肌梗死之间没有关联;但是,在同一多变量调整模型中,高中以下教育程度与心肌梗死风险较高有关(HR,1.52 [95% CI,1.06-2.17])。结论在一个慢性肾脏病队列中,邻里水平的社会经济状况与肾功能较好的人发生心力衰竭以及60岁以下人群的死亡有关。由于慢性肾脏病(CKD)患者的心血管并发症发生率较高,我们利用慢性肾功能不全队列研究的数据评估了邻里社会经济地位(SES)与心血管预后之间的关系。我们发现,居住在条件较差的社区与轻度慢性肾脏病患者发生心力衰竭的风险较高以及年龄小于 60 岁的患者死亡风险较高有关。这些发现突出表明,需要采取公共卫生和卫生系统干预措施来解决这些差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Kidney Medicine
Kidney Medicine Medicine-Internal Medicine
CiteScore
4.80
自引率
5.10%
发文量
176
审稿时长
12 weeks
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