Original Investigation
Pathogenesis and Treatment of Kidney Disease
Association of Socioeconomic Status and CKD Among African Americans: The Jackson Heart Study

https://doi.org/10.1053/j.ajkd.2010.01.016Get rights and content

Background

Socioeconomic status (SES) is recognized as a key social environmental factor because it has implications for access to resources that help individuals care for themselves and others. Few studies have examined the association of SES with chronic kidney disease (CKD) in high-risk populations.

Study Design

Single-site longitudinal population-based cohort.

Setting & Participants

Data for this study were drawn from the baseline examination of the Jackson Heart Study. The analytic cohort consisted of 3,430 African American men and women living in the tricounty region of the Jackson, MS, metropolitan area with complete data to determine CKD status.

Predictor

High SES (defined as having a family income at least 3.5 times the poverty level or having at least 1 undergraduate degree).

Outcomes & Measurements

CKD (defined as the presence of albuminuria or decreased estimated glomerular filtration rate [<60 mL/min/1.73 m2]). Associations were explored using bivariable analyses and multivariable logistic regression analyses adjusting for CKD and cardiovascular disease risk factors, as well as demographic factors.

Results

The prevalence of CKD in the Jackson Heart Study was 20% (865 of 3,430 participants). Proportions of the Jackson Heart Study cohort with albuminuria and decreased estimated glomerular filtration rate were 12.5% (429 of 3,430 participants) and 10.1% (347 of 3,430 participants), respectively. High SES was associated inversely with CKD. The odds of having CKD were 41% lower for affluent participants than their less affluent counterparts. There were no statistically significant interactions between sex and education or income, although subgroup analysis showed that high income was associated with CKD in men (OR, 0.47; 95% CI, 0.23-0.97), but not women (OR, 0.64; 95% CI, 0.40-1.03).

Limitations

Models were estimated using cross-sectional data.

Conclusion

CKD is associated with SES. Additional research is needed to elucidate the impact of wealth and social contexts in which individuals are embedded and the mediating effects of sociocultural factors.

Section snippets

Study Population and Measurements

Data for this study were drawn from the baseline examination of the Jackson Heart Study, a single-site longitudinal population-based cohort study prospectively investigating the determinants of cardiovascular disease (CVD) in African Americans living in the tricounty region (Hinds, Madison, and Rankin counties) of the Jackson, MS, metropolitan area. Baseline data collection occurred between September 2000 and March 2004. Recruitment, sampling, and data collection methods have been described

Results

As previously reported, 1,015 Jackson Heart Study participants completed 24-hour urine collections.12 Spot urine collections were added later to the protocol (n = 2,225); however, a substantial segment of the study population did not have sufficient urine data to determine CKD status (n = 1,792). Other individuals were excluded if they did not have sufficient serum data to determine CKD status (n = 56) or had restricted consent (n = 23). Excluded participants were more likely to be older, not

Discussion

This study extends our initial analyses of indicators of CKD prevalence and awareness12 and prior research that focuses on economic deprivation and its implications for excess risks for outcomes such as CKD.7, 8, 9, 10, 11, 28 Our research suggests that affluence also has implications for kidney disease in African Americans. As expected, affluent or highly educated African American participants in the Jackson Heart Study had lower risks of CKD relative to their poor or less educated

Acknowledgements

Support: This research was supported by National Institutes of Health contracts N01-HC-95170, N01-HC-95171, and N01-HC-95172 that were provided by the National Heart, Lung, and Blood Institute (NHLBI), the National Center for Minority Health and Health Disparities, and the National Institute of Biomedical Imaging and Bioengineering and career development awards from the NHLBI to Meharry Medical College (1 K01 HL88735-01; Dr Bruce) and the University of Mississippi Medical Center (1 K01

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    Originally published online as doi:10.1053/j.ajkd.2010.01.016 on April 9, 2010.

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