title: Lower socioeconomic status and disability among US adults with chronic kidney disease, 1999-2008.
abstract: BACKGROUND
  Socioeconomic disparities are associated with the prevalence of disability in the general population; however, it is unknown whether a similar association exists between socioeconomic status and disability from chronic kidney disease (CKD, defined as albuminuria or an estimated glomerular filtration rate of 15-59 mL/min/1.73 m(2)).
  
  
  METHODS
  A total of 4,257 US adults aged 20 years or older with CKD who participated in the National Health and Nutrition Examination Survey 1999-2008 completed standardized questionnaires assessing self-reported difficulties in activities of daily living (ADL), instrumental ADL (IADL), lower-extremity mobility (LEM), and leisure and social activities (LSA). We used multivariable logistic regression with population-based weighting to obtain adjusted prevalence estimates of disability by demographic, socioeconomic, health care access, and clinical characteristics.
  
  
  RESULTS
  Participants with less education had more disability (age- and sex-adjusted prevalence of disability by lowest vs highest level of education: ADL, 24.5% vs 16.9%; IADL, 34.0% vs 20.3%; LEM, 56.9% vs 44.6%; LSA, 26.2% vs 16.8%; P < .001 for all). We observed similar trends for income. After further adjustment for other sociodemographic factors, health care access, and comorbid conditions, education and income both remained significantly associated, by any measure, with lower prevalence of disability.
  
  
  CONCLUSIONS
  Among people with CKD in the United States, lower socioeconomic status is associated with greater risk of disability, independent of race/ethnicity, health care access, and comorbid conditions. Our findings suggest that people with CKD and limited education or lower income should be targeted for early intervention to limit disability and further loss of income, both of which could worsen outcomes in CKD.
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Claudia Nance Rollins Building, Floor 3, 1518 Clifton Road NE, Atlanta, GA 30322, USA. laura.plantinga@emory.edu
authors.forename: Laura C
authors.initials: LC
authors.lastname: Plantinga
authors.forename: Kirsten L
authors.initials: KL
authors.lastname: Johansen
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
authors.forename: Neil R
authors.initials: NR
authors.lastname: Powe
mesh_terms: D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D015995:Prevalence; D012189:Retrospective Studies; D012923:Social Class; D014481:United States / Q000453:epidemiology; D055815:Young Adult