title: Diabetes, hypertension, obesity, and long-term risk of renal disease mortality: Racial and socioeconomic differences.
abstract: OBJECTIVE
  Diabetes, hypertension, and obesity increase the risk of chronic kidney disease and associated mortality. Race and socioeconomic status (SES) differences in the effects of these risk factors are, however, still unknown. The current study aimed to investigate whether or not race and SES alter the effects of diabetes, hypertension, and obesity on mortality due to renal disease.
  
  
  METHODS
  Data came from the Americans' Changing Lives Study, 1986-2011, a nationally representative prospective cohort of adults with 25 years of follow up. The study included 3,361 adults aged 25 years and older who were followed for up to 25 years. The outcome was death from renal disease. Diabetes, hypertension, and obesity were the main predictors. Race and SES (education, income, and employment) were moderators. Health behaviors and health status at baseline were covariates. We used Cox proportional hazards models for data analysis.
  
  
  RESULTS
  In separate models, diabetes, hypertension, and obesity at baseline were associated with a higher risk of death from renal disease. From our SES indicators, education and income interacted with diabetes, hypertension, and obesity on death from renal disease. In a consistent pattern, diabetes, hypertension, and obesity showed stronger effects on the risk of death from renal disease among high-SES groups compared with low-SES individuals. Race and employment did not alter the effects of diabetes, hypertension and obesity on the risk of death from renal disease.
  
  
  CONCLUSIONS
  Social groups differ in how diabetes, hypertension, and obesity influence health outcomes over long-term periods. Elimination of disparities in renal disease mortality in the USA requires understanding of the complex and non-linear effects of socioeconomic and medical risk factors on health outcomes. Multidisciplinary programs and policies are required to reduce social inequality in renal disease burden caused by diabetes, hypertension, and obesity.
authors.affiliation: Medicine and Health Promotion Institute, Tehran, Iran.
authors.forename: Maryam
authors.initials: M
authors.lastname: Moghani Lankarani
authors.affiliation: Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.|Center for Research on Ethnicity, Culture, and Health, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: Shervin
authors.identifier: http://orcid.org/0000-0002-5054-6250
authors.initials: S
authors.lastname: Assari
mesh_terms: D015331:Cohort Studies; D003928:Diabetic Nephropathies / Q000150:complications / Q000208:ethnology / Q000401:mortality; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000208:ethnology; D007674:Kidney Diseases / Q000150:complications / Q000208:ethnology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000208:ethnology; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
keywords: Diabetes; Renal diseases; Social class