title: The impact of disadvantage on the development and progression of diabetic kidney disease.
abstract: BACKGROUND
  Disadvantaged people include those experiencing economic, social or educational deprivation and, in some cases, those undergoing rapid transition from subsistence to industrial economies. Disadvantaged people worldwide are affected disproportionately by the global epidemic of diabetes. They are also at increased risk of kidney disease attributable to diabetes, and for many, the cost of managing their kidney disease far exceeds their available resources.
  
  
  METHODS
  We review factors associated with disadvantage that may increase the risk of diabetic kidney disease, and the barriers to care that hinder attempts to provide an adequate therapeutic response.
  
  
  CONCLUSIONS
  A rapidly rising prevalence and magnitude of obesity among children and adults, increasing frequency of intrauterine exposure to diabetes, and inadequate access to healthcare are responsible, in part, for a surge in the frequency of diabetes and, in turn, diabetic kidney disease among disadvantaged people. These factors may also predispose to an earlier onset of diabetes and kidney disease, thereby perpetuating the disadvantage by reducing the earning potential of those affected through illness and disability.
authors.affiliation: Diabetes Epidemiology and Clinical Research Section, Phoenix Epidemiology and Clinical Research Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Weil
authors.forename: J M
authors.initials: JM
authors.lastname: Curtis
authors.forename: R L
authors.initials: RL
authors.lastname: Hanson
authors.forename: W C
authors.initials: WC
authors.lastname: Knowler
authors.forename: R G
authors.initials: RG
authors.lastname: Nelson
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003928:Diabetic Nephropathies / Q000453:epidemiology* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005317:Fetal Growth Retardation; D006801:Humans; D011247:Pregnancy; D012959:Socioeconomic Factors; D035862:Vulnerable Populations