The cumulative impact of social determinants of health factors on mortality in adults with diabetes and chronic kidney disease

BMC Nephrology

Rebekah J. Walker¹  Emma Garacci¹  Leonard E. Egede¹  Anna Palatnik²  Mukoso N. Ozieh³ 

[1] Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA;Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA;Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA;Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA;Department of Medicine, Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI, USA;Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA;Division of Nephrology, Clement J. Zablocki VA Medical Center, Milwaukee, WI, USA;

关键词: Social determinants;    Mortality;    Kidney disease;    Diabetes;   

DOI  :  10.1186/s12882-021-02277-2

来源: Springer

【 摘 要 】

BackgroundA growing body of evidence supports the potential role of social determinants of health on health outcomes. However, few studies have examined the cumulative effect of social determinants of health on health outcomes in adults with chronic kidney disease (CKD) with or without diabetes. This study examined the cumulative impact of social determinants of health on mortality in U.S. adults with CKD and diabetes.MethodsWe analyzed data from National Health and Nutrition Examination Surveys (2005–2014) for 1376 adults age 20 and older (representing 7,579,967 U.S. adults) with CKD and diabetes. The primary outcome was all-cause mortality. CKD was based on estimated glomerular filtration rate and albuminuria. Diabetes was based on self-report or Hemoglobin A1c of ≥6.5%. Social determinants of health measures included family income to poverty ratio level, depression based on PHQ-9 score and food insecurity based on Food Security Survey Module. A dichotomous social determinant measure (absence vs presence of ≥1 adverse social determinants) and a cumulative social determinant score ranging from 0 to 3 was constructed based on all three measures. Cox proportional models were used to estimate the association between social determinants of health factors and mortality while controlling for covariates.ResultsCumulative and dichotomous social determinants of health score were significantly associated with mortality after adjusting for demographics, lifestyle variables, glycemic control and comorbidities (HR = 1.41, 95%CI 1.18–1.68 and HR = 1.41, 95%CI 1.08–1.84, respectively). When investigating social determinants of health variables separately, after adjusting for covariates, depression (HR = 1.52, 95%CI 1.10–1.83) was significantly and independently associated with mortality, however, poverty and food insecurity were not statistically significant.ConclusionsSpecific social determinants of health factors such as depression increase mortality in adults with chronic kidney disease and diabetes. Our findings suggest that interventions are needed to address adverse determinants of health in this population.

【 授权许可】

CC BY