Low income and albuminuria among REGARDS (Reasons for Geographic and Racial Differences in Stroke) study participants.
BACKGROUND
Albuminuria is an important risk factor for progressive chronic kidney disease (CKD) and is more prevalent in black than white adults. We sought to determine the association between low income and albuminuria and whether this association differs for blacks and whites.


METHODS
Cross-sectional study.


METHODS
9,144 black and 13,684 white US adults 45 years and older in the population-based Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study.


METHODS
Self-reported annual household income category (≥$75,000, $35,000-$74,999, $20,000-$34,999, and <$20,000); black and white race.


METHODS
Albuminuria defined as high (30-300 mg/g) or very high (>300 mg/g) urinary albumin-creatinine ratio (ACR). Multinomial logistic regression used to examine the race-stratified association between categories of income and albuminuria (normal, high, or very high ACR).


RESULTS
Overall, geometric mean ACR was 10.2 mg/g and was higher for blacks (11.8 mg/g) than whites (9.3 mg/g), P<0.001. Lower income was associated with a higher prevalence of albuminuria for both whites and blacks in unadjusted analyses. After adjustment for demographics, lifestyle factors, comorbid illnesses, and estimated glomerular filtration rate, there was a trend toward a stronger association between lower income levels and high ACR in blacks (ORs of 1.38 [95% CI, 1.07-1.77], 1.36 [95% CI, 1.05-1.75], and 1.58 [95% CI, 1.21-2.05] for income levels of $35,000-$74,999, $20,000-$34,999, and <$20,000, respectively; reference group is those with income≥$75,000) compared with whites (ORs of 0.95 [95% CI, 0.81-1.12], 0.95 [95% CI, 0.79-1.14], and 1.26 [95% CI, 1.02-1.55], respectively); P interaction=0.08 between race and income. Results were similar for very high ACR and subgroups of participants with diabetes or hypertension.


CONCLUSIONS
Cross-sectional design; not all REGARDS participants provided their annual income.


CONCLUSIONS
Lower income may be associated more strongly with albuminuria in blacks than whites and may be a determinant of racial disparities in albuminuria.
Division of Nephrology, Department of Medicine, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD 21224, USA. dcrews1@jhmi.edu
Deidra C
DC
Crews
William M
WM
McClellan
David A
DA
Shoham
Liyan
L
Gao
David G
DG
Warnock
Suzanne
S
Judd
Paul
P
Muntner
Edgar R
ER
Miller
Neil R
NR
Powe
D001741:Black or African American; D000368:Aged; D000419:Albuminuria / Q000453:epidemiology*; D044383:Black People; D003430:Cross-Sectional Studies; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty; D014481:United States