社会经济地位与肾功能障碍风险：社区动脉粥样硬化风险研究。
Socioeconomic status and risk of kidney dysfunction: the Atherosclerosis Risk in Communities study.
机构信息
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Johns Hopkins University School of Medicine, Baltimore, MD, USA.
出版信息
Nephrol Dial Transplant. 2019 Aug 1;34(8):1361-1368. doi: 10.1093/ndt/gfy142.
BACKGROUND
There is strong evidence of an association between socioeconomic status (SES) and end-stage renal disease (ESRD). However, the association of SES with the risk of chronic kidney disease (CKD) and the rate of change in kidney function is unclear.
METHODS
A cohort of 14 086 participants with an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 at baseline in the Atherosclerosis Risk in Communities study (1987-89) were studied. The association of annual household income, educational attainment and neighborhood deprivation with incident ESRD, incident CKD and change in eGFR using four measurements over ∼23 years was assessed.
RESULTS
A total of 432 participants developed ESRD and 3510 developed CKD over a median follow-up time of ∼23 years. After adjustment for demographics and baseline eGFR, the hazard ratio (HR) for incident ESRD compared with the high-income group was 1.56 [95% confidence interval (CI) 1.22-1.99 in the medium-income group and 2.30 (95% CI 1.75-3.02) in the low-income group (P-trend < 0.001), and for CKD was 1.10 (95% CI 1.01-1.20) in the medium-income group and 1.30 (95% CI 1.17-1.44) in the low-income group (P-trend < 0.001). After full adjustments, the HR for ESRD was 1.33 (95% CI 1.03-1.70) in the medium-income group and 1.50 (95% CI 1.14-1.98) in the low-income group (P-trend = 0.003) and for CKD was 1.01 (95% CI 0.92-1.10) in the medium-income group and 1.04 (95% CI 0.93-1.16) in the low-income group (P-trend = 0.50). The eGFR decline was 5% and 15% steeper in the medium- and low-income groups, respectively, after full adjustment (P-trend < 0.001). Results were similar, with lower educational attainment and higher neighborhood deprivation being associated with adverse outcomes.
CONCLUSIONS
SES (annual household income, educational attainment or neighborhood deprivation) was associated not only with ESRD risk but also with eGFR decline, although the association with CKD appeared weaker.
背景
有强有力的证据表明社会经济地位（SES）与终末期肾脏疾病（ESRD）之间存在关联。然而，SES 与慢性肾脏病（CKD）风险和肾功能变化率之间的关系尚不清楚。
方法
在社区动脉粥样硬化风险研究（1987-89 年）中，对基线时估计肾小球滤过率（eGFR）≥60 mL/min/1.73 m2 的 14086 名参与者进行了研究。使用 4 次测量值在大约 23 年内评估了年度家庭收入、教育程度和社区贫困程度与新发 ESRD、新发 CKD 和 eGFR 变化之间的关系。
结果
中位随访时间约为 23 年后，共有 432 名参与者发生 ESRD，3510 名参与者发生 CKD。在校正人口统计学和基线 eGFR 后，与高收入组相比，低收入组的 ESRD 发病风险比（HR）为 1.56（95%CI 1.22-1.99），中收入组为 2.30（95%CI 1.75-3.02）（P趋势<0.001），CKD 的发病风险比（HR）在中收入组为 1.10（95%CI 1.01-1.20），在低收入组为 1.30（95%CI 1.17-1.44）（P趋势<0.001）。在充分调整后，中收入组的 ESRD HR 为 1.33（95%CI 1.03-1.70），低收入组为 1.50（95%CI 1.14-1.98）（P趋势=0.003），CKD 的 HR 为 1.01（95%CI 0.92-1.10）在中收入组中，在低收入组中为 1.04（95%CI 0.93-1.16）（P趋势=0.50）。经过充分调整后，中低收入组的 eGFR 下降分别为 5%和 15%（P趋势<0.001）。结果相似，较低的教育程度和较高的社区贫困程度与不良结局相关。
结论
SES（家庭年收入、教育程度或社区贫困程度）不仅与 ESRD 风险相关，还与 eGFR 下降相关，尽管与 CKD 的相关性似乎较弱。
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