Department of Health Sciences, Community and Occupational Medicine and, †Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands, and, ‡Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Clin J Am Soc Nephrol. 2013 Oct;8(10):1685-93. doi: 10.2215/CJN.12521212. Epub 2013 Jun 27.
According to the cost of health care utilization systems, there may be regional differences in the relative strength of association of income and education-based socioeconomic status measures with CKD. This study investigated the relative strength of the association of income and education with CKD in a United States and a Dutch population.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This cross-sectional study examined individuals who participated in the 1999-2002 National Health and Nutritional Examination Survey (NHANES) and in Prevention of Renal and Vascular End-stage Disease (PREVEND 1997-1998), general population-based cohorts in the United States and The Netherlands, respectively. The main outcome was CKD, defined as estimated GFR <60 ml/min per 1.73 m(2) (using creatinine) or albuminuria ≥ 30 mg/24 hours or albumin-to-creatinine ratio ≥ 30 mg/g.
In NHANES (n=6428), income was strongly associated with CKD (adjusted odds ratio, 2.34 [95% confidence interval (CI), 1.68 to 3.27]; P for trend<0.001) but education was not (adjusted odds ratio, 1.62 [95% CI, 0.87 to 2.25]; P for trend=0.05]. In contrast, in PREVEND (n=7983), low income was weakly associated with CKD whereas low education had a strong association. The fit of the logistic regression model estimating association of income and education with CKD was significantly improved only after income was added in NHANES (P<0.001) and education was added in PREVEND (P=0.01). Sensitivity analyses that used other CKD-defining variables and restricted analyses to participants <65 years of age resulted in similar findings.
In the United States, where access to health care is traditionally income dependent, income appeared more strongly associated with CKD than in The Netherlands, where education showed a stronger association.
根据医疗保健利用系统的成本，收入和基于教育的社会经济地位指标与 CKD 的关联强度可能存在地域差异。本研究调查了美国和荷兰人群中收入和教育与 CKD 的关联强度。
设计、设置、参与者和测量：本横断面研究调查了分别参加 1999-2002 年全国健康和营养检查调查（NHANES）和预防肾脏和血管终末期疾病（PREVEND 1997-1998）的个体，这是美国和荷兰的两个基于一般人群的队列。主要结局是 CKD，定义为估计肾小球滤过率<60 ml/min/1.73 m2（用肌酐）或白蛋白尿≥30 mg/24 小时或白蛋白/肌酐比值≥30 mg/g。
在 NHANES（n=6428）中，收入与 CKD 密切相关（调整后的优势比，2.34[95%置信区间（CI），1.68 至 3.27]；P<0.001），但教育无关（调整后的优势比，1.62[95%CI，0.87 至 2.25]；P 趋势=0.05）。相比之下，在 PREVEND（n=7983）中，低收入与 CKD 相关较弱，而低教育则与 CKD 相关较强。仅在 NHANES 中加入收入（P<0.001）和 PREVEND 中加入教育（P=0.01）后，估计收入和教育与 CKD 关联的逻辑回归模型的拟合度才显著改善。使用其他 CKD 定义变量的敏感性分析和将分析限制在<65 岁的参与者中得出了类似的结果。
在美国，传统上医疗保健的可及性取决于收入，收入与 CKD 的关联比荷兰强，而荷兰的教育与 CKD 的关联更强。
