Anandh Urmila, Meena Priti, Karam Sabine, Luyckx Valerie
Department of Nephrology, Amrita Hospitals, Faridabad, Delhi NCR, India.
Department of Nephrology, All India Institute of Medical Sciences, Bhubaneshwar, India.
Front Nephrol. 2022 Oct 24;2:1024667. doi: 10.3389/fneph.2022.1024667. eCollection 2022.
The social determinants of health (SDoH) are the non-medical factors that influence kidney health outcomes directly or indirectly in a substantial manner and include conditions in which people are born, grow, work, live, and age. Many such challenges in lower- and middle- income countries have an unfavourable impact on kidney health. These conditions potentially influence economic policies and systems, development agendas, social norms, social policies, and political systems. In addition, many political and legal factors also determine and modify the ultimate outcome in patients with kidney disease. Legal factors that ensure universal health care, promote gender and racial equality, prevent malpractices and regulate strict laws in the field of kidney transplantation are the paramount determinants for the provision of necessary kidney care. Converging lines of evidence have supported the impact of social variables such as socioeconomic resources, social inclusion, housing conditions, educational attainment, and financial status on kidney health, particularly affect vulnerable and disadvantaged groups and result in challenges in kidney care delivery. Furthermore, the climate is an important SDoH that plays a crucial role in the occurrence, prevalence, and progression of kidney diseases as highlighted by the presence of higher prevalence of chronic kidney disease in hot tropical countries. The rising incidence of water and vector-borne diseases causing acute kidney injury is another consequence of disruptive environmental and climate change which is detrimental to kidney health. Political risk factors such as conflict also have a devastating influence on kidney health. The relationship between SDoH and kidney health outcomes requires more clarity. Gaps in the current knowledge need to be identified to inform the development of appropriate interventions to address upstream socio-economic risk factors for kidney disease.
健康的社会决定因素（SDoH）是指那些以重大方式直接或间接影响肾脏健康结果的非医学因素，包括人们出生、成长、工作、生活和衰老的环境。低收入和中等收入国家面临的许多此类挑战对肾脏健康产生不利影响。这些状况可能会影响经济政策和体系、发展议程、社会规范、社会政策及政治体系。此外，许多政治和法律因素也决定并改变肾病患者的最终结局。确保全民医保、促进性别和种族平等、防止医疗不当行为以及规范肾脏移植领域严格法律的法律因素，是提供必要肾脏护理的首要决定因素。越来越多的证据支持社会变量，如社会经济资源、社会包容、住房条件、教育程度和财务状况，对肾脏健康的影响，尤其会影响弱势群体和处境不利群体，并给肾脏护理的提供带来挑战。此外，气候是一个重要的健康社会决定因素，在肾脏疾病的发生、流行和进展中起着关键作用，正如热带炎热国家慢性肾病患病率较高所凸显的那样。导致急性肾损伤的水传播和病媒传播疾病发病率上升，是破坏性环境和气候变化对肾脏健康有害的另一个后果。冲突等政治风险因素也对肾脏健康有毁灭性影响。健康的社会决定因素与肾脏健康结果之间的关系需要更清晰的认识。需要找出当前知识中的差距，为制定适当干预措施提供依据，以应对肾脏疾病的上游社会经济风险因素。
