功能性和结构性社会支持与非裔美国人慢性肾脏病的关联：杰克逊心脏研究。
Association of functional and structural social support with chronic kidney disease among African Americans: the Jackson Heart Study.
机构信息
Duke University, Durham, NC, USA.
University of Mississippi Medical Center, Jackson, MS, USA.
出版信息
BMC Nephrol. 2019 Jul 15;20(1):262. doi: 10.1186/s12882-019-1432-9.
BACKGROUND
There is limited evidence on the relationship between social support and renal outcomes in African Americans. We sought to determine the association of social support with prevalent chronic kidney disease (CKD) and kidney function decline in an African American cohort. We also examined whether age modifies the association between social support and kidney function decline.
METHODS
We identified Jackson Heart Study (JHS) participants with baseline (Exam in 2000-2004) functional and structural social support data via the Interpersonal Support Evaluation List (ISEL) and social network size questions, respectively. With ISEL as our primary exposure variable, we performed multivariable regression models to evaluate the association between social support and prevalent CKD [estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 or urine albumin-creatinine ratio (ACR) ≥30 mg/g], eGFR decline, and rapid renal function decline (RRFD) (> 30% decrease in eGFR over approximately 10 years). All models were adjusted for baseline sociodemographics, diabetes, hypertension, smoking status, and body mass index; models for eGFR decline and RRFD were additionally adjusted for eGFR and ACR. In models for eGFR decline, we assessed for interaction between age and social support. For secondary analyses, we replaced ISEL with its individual domains (appraisal, belonging, self-esteem, and tangible) and social network size in separate models as exposure variables.
RESULTS
Of 5301 JHS participants, 4015 (76%) completed the ISEL at baseline. 843 (21%) had low functional social support (ISEL score < 32). Participants with low (vs. higher) functional social support were more likely to have lower income (47% vs. 28%), be current or former tobacco users (39% vs. 30%), have diabetes (25% vs. 21%) or CKD (14% vs. 12%). After multivariable adjustment, neither ISEL or social network size were independently associated with prevalent CKD, eGFR decline, or RRFD. Of the ISEL domains, only higher self-esteem was associated with lower odds of prevalent CKD [OR 0.94 (95% CI 0.89-0.99)]. The associations between social support measures and eGFR decline were not modified by age.
CONCLUSIONS
In this African-American cohort, social support was not associated with prevalent CKD or kidney function decline. Further inquiry of self-esteem's role in CKD self-management and renal outcomes is warranted.
背景
关于社会支持与非裔美国人肾脏结局之间的关系，目前证据有限。我们旨在确定社会支持与非裔美国人队列中普遍存在的慢性肾脏病（CKD）和肾功能下降之间的关联。我们还研究了年龄是否改变了社会支持与肾功能下降之间的关系。
方法
我们通过人际关系支持评估清单（ISEL）分别识别出基线（2000-2004 年的考试）具有功能和结构社会支持数据的杰克逊心脏研究（JHS）参与者，以及社交网络规模问题。我们将 ISEL 作为主要暴露变量，使用多变量回归模型来评估社会支持与普遍存在的 CKD[估计肾小球滤过率（eGFR）<60ml/min/1.73m2或尿白蛋白-肌酐比（ACR）≥30mg/g]、eGFR 下降和快速肾功能下降（RRFD）（eGFR 在大约 10 年内下降>30%）之间的关联。所有模型均根据基线社会人口统计学、糖尿病、高血压、吸烟状况和体重指数进行了调整；eGFR 下降和 RRFD 的模型还根据 eGFR 和 ACR 进行了调整。在 eGFR 下降模型中，我们评估了年龄与社会支持之间的相互作用。在次要分析中，我们分别将 ISEL 及其各个领域（评估、归属、自尊和有形）和社交网络规模作为暴露变量替代。
结果
在 5301 名 JHS 参与者中，有 4015 名（76%）在基线时完成了 ISEL。843 名（21%）的功能性社会支持较低（ISEL 评分<32）。与低功能社会支持（ISEL 评分<32）相比，功能较高（ISEL 评分≥32）的参与者更有可能收入较低（47%对 28%）、当前或以前是吸烟者（39%对 30%）、患有糖尿病（25%对 21%）或 CKD（14%对 12%）。经过多变量调整后，ISEL 或社交网络规模均与普遍存在的 CKD、eGFR 下降或 RRFD 无关。在 ISEL 领域中，只有更高的自尊与较低的 CKD 患病率相关[OR 0.94（95%CI 0.89-0.99）]。社会支持措施与 eGFR 下降之间的关联不受年龄的影响。
结论
在这项非裔美国人队列研究中，社会支持与普遍存在的 CKD 或肾功能下降无关。进一步研究自尊在 CKD 自我管理和肾脏结局中的作用是必要的。
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