Xie Chengpeng, Wu Qian, Xie Chengxin, Shi Zhien
Department of Urology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
Department of Orthopedic Surgery and Sports Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China.
Prev Med Rep. 2025 Jun 9;55:103132. doi: 10.1016/j.pmedr.2025.103132. eCollection 2025 Jul.
To explore the association between social determinants of health (SDoH) and chronic kidney disease (CKD) prevalence and prognosis in the US population.
Data were sourced from the US National Health and Nutrition Examination Survey 2003-2018, including 32,389 participants aged ≥20 years. Unfavorable SDoH included unemployment, low income, food insecurity, low education, lack of healthcare access, lack of health insurance, housing instability, and not being married or living with a partner. CKD prevalence and poor prognosis were the primary outcomes. A cumulative SDoH score assessed the overall association with CKD, while individual scores were examined for their independent associations. Multivariable logistic regression, restricted cubic splines, and subgroup analysis were conducted.
Cumulative SDoH scores were associated with CKD prevalence (OR = 1.14, 95 %CI: 1.11-1.16) and poor prognosis (OR = 1.17, 95 %CI: 1.12-1.22). A nonlinear relationship existed between Cumulative SDoH scores and prevalence, while the association with prognosis was linear. Unemployment (OR = 1.13, 95 %CI: 1.01-1.27), low income (OR = 1.38, 95 %CI: 1.25-1.52), low education (OR = 1.15, 95 %CI: 1.05-1.27), lack of health insurance (OR = 1.11, 95 %CI: 1.01-1.21), housing instability (OR = 1.17, 95 %CI: 1.05-1.29), and not married nor living with a partner (OR = 1.12, 95 %CI: 1.01-1.25) were associated with prevalence. Unemployment (OR = 1.42, 95 %CI: 1.16-1.74), low income (OR = 1.48, 95 %CI: 1.28-1.71), low education (OR = 1.19, 95 %CI: 1.04-1.38), and housing instability (OR = 1.42, 95 %CI: 1.23-1.66) were associated with poor prognosis.
Unfavorable SDoH are positively associated with both CKD prevalence and poor prognosis.
探讨美国人群中健康的社会决定因素（SDoH）与慢性肾脏病（CKD）患病率及预后之间的关联。
数据来源于2003 - 2018年美国国家健康与营养检查调查，包括32389名年龄≥20岁的参与者。不良的SDoH包括失业、低收入、粮食不安全、低教育水平、缺乏医疗服务可及性、缺乏医疗保险、住房不稳定以及未婚或未与伴侣同住。CKD患病率和不良预后是主要结局。累积SDoH评分评估与CKD的总体关联，同时检查个体评分的独立关联。进行了多变量逻辑回归、受限立方样条分析和亚组分析。
累积SDoH评分与CKD患病率（OR = 1.14，95%CI：1.11 - 1.16）和不良预后（OR = 1.17，95%CI：1.12 - 1.22）相关。累积SDoH评分与患病率之间存在非线性关系，而与预后的关联是线性的。失业（OR = 1.13，95%CI：1.01 - 1.27）、低收入（OR = 1.38，95%CI：1.25 - 1.52）、低教育水平（OR = 1.15，95%CI：1.05 - 1.27）、缺乏医疗保险（OR = 1.11，95%CI：1.01 - 1.21）、住房不稳定（OR = 1.17，95%CI：1.05 - 1.29）以及未婚或未与伴侣同住（OR = 1.12，95%CI：1.01 -
