Socio-economic impact in CKD.

BACKGROUND

Socio-economic status (SES) may be conceptualized as an individual's position in society, as determined by their income, occupation, education, wealth, and housing situation. This review summarizes the current literature regarding associations of these markers of SES with both chronic kidney disease (CKD) and associated poor outcomes.

METHODS

Literature searches were conducted in the US National Library of Medicine, National Institutes of Health, PubMed database using the search terms "chronic kidney disease" and "chronic renal insufficiency," combined with "socio-economic status," "income," "occupation," "employment," "education," "social class," "wealth," and "housing." Articles not in the English language, using non-human subjects, or primarily concerning subjects with ESRD or acute kidney injury were excluded.

RESULTS

Income is the most-studied aspect of SES in relation to CKD, but there is increasing literature involving occupation and education as well. Additionally, the associations of CKD and its outcomes with area-level and life course SES are both burgeoning areas of research. There are several research areas that remain mostly unexplored, including the roles of wealth and housing in defining SES-related risk in CKD. Additionally, none have explored the relative utility of composite versus individual indicators of SES in predicting risk of CKD and outcomes.

CONCLUSION

Given the overwhelming evidence that SES plays an important role in the development and progression of disease, the development and testing of more targeted interventions should be a top priority in CKD research. Continuing examination of these factors, with increased rigor and focus on potentially modifiable intermediate pathways, is needed.