Association Between Income Disparities and Risk of Chronic Kidney Disease: A Nationwide Cohort Study of Seven Million Adults in Korea

Tae Ik Chang, Hyunsun Lim, Cheol Ho Park, Connie M. Rhee, Kamyar Kalantar-Zadeh, Ea Wha Kang, Shin Wook Kang, Seung Hyeok Han

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2 Citations (Scopus)

Abstract

Objective: To examine the association between income level and incident chronic kidney disease (CKD) in adults with normal baseline kidney function. Patient and Methods: We studied the association between income level categorized into deciles and incident CKD in a national cohort comprised of 7,405,715 adults who underwent National Health Insurance Service health examinations during January 1, 2009, to December 31, 2015, with baseline estimated glomerular filtration rates (eGFRs) ≥60 mL/min/1.73 m2. Incident CKD was defined as de novo development of eGFR <60 mL/min/1.73 m2 (model 1) or ≥25% decline in eGFR from baseline values accompanied by eGFR <60 mL/min/1.73 m2 (model 2). Results: During a median follow-up of 4.8 years, there were 122,032 of 7,405,715 (1.65%) and 55,779 of 7,405,715 (0.75%) incident CKD events based on model 1 and 2 definitions, respectively. Compared with income levels in the sixth decile, there was an inverse association between lower income level and higher risk for CKD up to the fourth decile, above which no additional reduction (model 1) or slightly higher risk for CKD (model 2) was observed at higher income levels. The multivariable-adjusted hazard ratios from the lowest to fourth deciles were 1.30 (95% CI, 1.26-1.33), 1.16 (95% CI, 1.13-1.19), 1.07 (95% CI, 1.05-1.10), and 1.06 (95% CI, 1.03-1.09) in model 1 and 1.32 (95% CI, 1.27-1.37), 1.18 (95% CI, 1.14-1.22), 1.08 (95% CI, 1.04-1.13), and 1.05 (95% CI, 1.01-1.09) in model 2, respectively. These associations persisted across various subgroups of age, sex, and comorbidity status. Conclusion: In this large nationwide cohort, lower income levels were associated with higher risk for incident CKD.

Original languageEnglish
Pages (from-to)231-242
Number of pages12
JournalMayo Clinic Proceedings
Volume95
Issue number2
DOIs
Publication statusPublished - 2020 Feb

Bibliographical note

Funding Information:
Grant Support: This work was supported by a grant ( NHIMC 2017-12-013 ) funded by National Health Insurance Service Medical Center, Ilsan Hospital. The funding source had no role in study design, data collection, data analysis, decision to publish, or preparation of the manuscript. K.K.-Z. is supported by National Institutes of Health ( National Institute of Diabetes and Digestive and Kidney Diseases ) grants K24-DK091419 , U01-DK102163 , and philanthropic grants from Mr. Harold Simmons, Mr. Louis Change, Joseph Lee, and AVEO, Inc. C.M.R. is supported by National Institutes of Health ( National Institute of Diabetes and Digestive and Kidney Diseases ) grants K23-DK102903 and R03-DK114642 .

Funding Information:
Grant Support: This work was supported by a grant (NHIMC 2017-12-013) funded by National Health Insurance Service Medical Center, Ilsan Hospital. The funding source had no role in study design, data collection, data analysis, decision to publish, or preparation of the manuscript. K.K.-Z. is supported by National Institutes of Health (National Institute of Diabetes and Digestive and Kidney Diseases) grants K24-DK091419, U01-DK102163, and philanthropic grants from Mr. Harold Simmons, Mr. Louis Change, Joseph Lee, and AVEO, Inc. C.M.R. is supported by National Institutes of Health (National Institute of Diabetes and Digestive and Kidney Diseases) grants K23-DK102903 and R03-DK114642.

Publisher Copyright:
© 2019 Mayo Foundation for Medical Education and Research

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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