Kidney disease in life-course socioeconomic context: the Atherosclerosis Risk in Communities (ARIC) Study.
BACKGROUND
Persons belonging to the working class or living in an adverse social environment at particular periods of their life course may have an increased risk of chronic kidney disease (CKD).


METHODS
This hypothesis was examined among participants of the Life Course Socioeconomic Status Study, an ancillary study of the Atherosclerosis Risk in Communities Study, conducted in 2001 (mean age, 67.4 years; N = 12,631). CKD was defined by hospital discharge diagnosis and/or estimated glomerular filtration rate less than 45 mL/min/1.73 m(2) (<0.75 mL/s/1.73 m(2)). Social class was categorized as working class or non-working class at ages 30, 40, or 50 years. Area-level socioeconomic status was based on a composite of census scores during the same period. Adjusted odds ratios were obtained within strata of white and African-American race.


RESULTS
The adjusted odds ratio of CKD for persons belonging to the working class versus non-working class at age 30 was 1.4 (95% confidence interval, 1.0 to 2.0) in whites and 1.9 (95% confidence interval, 1.1 to 3.0) in African Americans. Working class membership was associated with CKD, even at earlier stages of adult life, and class was associated more strongly with CKD than was education. Working class membership also suggested a stronger association with CKD among African Americans than whites, independent of diabetes and hypertension status. At later periods in the life course, area socioeconomic status was associated with CKD.


CONCLUSIONS
Socioeconomic factors, including area socioeconomic status and social class, are associated with CKD and may account for some of the racial disparity in kidney disease.
Shoham
David A
DA
Department of Epidemiology, School of Public Health, and UNC Kidney Center, University of North Carolina, Chapel Hill, NC 27599-7156, USA.
Vupputuri
Suma
S
Diez Roux
Ana V
AV
Kaufman
Jay S
JS
Coresh
Josef
J
Kshirsagar
Abhijit V
AV
Zeng
Donglin
D
Heiss
Gerardo
G
D001741:Black or African American; D000375:Aging; D050197:Atherosclerosis / Q000191:economics* / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007674:Kidney Diseases / Q000191:economics* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D044465:White People