Annals of medicine · 2026
Impact of area socioeconomic deprivation on major adverse renal events in patients with acute kidney injury: a retrospective cohort study of a single-center national patient population.
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Yu Xiang, Gong XinYan, Wang BaoLong, Ji YuWei, Nie SaSa, Wu RiLiGe, Wang WanLing, Huang MengJie, Cai GuangYan, Feng Zhe
Аннотация
BACKGROUND: To investigate the impact of area socioeconomic deprivation on the risk of major adverse kidney events (MAKEs) within 90 days post-discharge among patients with acute kidney injury (AKI).
METHODS: This retrospective cohort study included patients with AKI between January 1, 2014, and December 31, 2023. Area socioeconomic deprivation index was calculated using principal component analysis based on district-level economic and healthcare resource data from patients' registered residential areas. Patients were stratified into four deprivation quartiles (Q1-Q4) and analyzed with multivariable Cox proportional hazards regression models to assess the association between deprivation index and MAKE risk.
RESULTS: Among 5,934 AKI patients, 1,107 (18.7%) experienced MAKEs within 90-day follow-up. Multivariable Cox regression analysis revealed that patients in the highest deprivation quartile (Q4) had a significantly greater risk of MAKEs than those in the lowest deprivation quartile (Q1) (hazard ratio [HR] 1.48, 95% CI: 1.24-1.77), with a significant dose-response relationship between MAKE risk and (trend p < 0.001). Subgroup analysis revealed that the negative effect of area socioeconomic deprivation was more pronounced among patients with lower levels of health insurance coverage (resident medical insurance/Self-pay) (interaction p = 0.032). Mediation analysis indicated that the delay between discharge and the first outpatient follow-up mediated approximately 23.2% of the area socioeconomic deprivation effect.
CONCLUSION: Area socioeconomic deprivation is a key socioenvironmental determinant of outcome in AKI patients. This finding suggests a significant association of macrolevel social environments on disease outcomes. Therefore, social environment assessments should be integrated into AKI clinical management systems for systematically reducing health inequalities.
METHODS: This retrospective cohort study included patients with AKI between January 1, 2014, and December 31, 2023. Area socioeconomic deprivation index was calculated using principal component analysis based on district-level economic and healthcare resource data from patients' registered residential areas. Patients were stratified into four deprivation quartiles (Q1-Q4) and analyzed with multivariable Cox proportional hazards regression models to assess the association between deprivation index and MAKE risk.
RESULTS: Among 5,934 AKI patients, 1,107 (18.7%) experienced MAKEs within 90-day follow-up. Multivariable Cox regression analysis revealed that patients in the highest deprivation quartile (Q4) had a significantly greater risk of MAKEs than those in the lowest deprivation quartile (Q1) (hazard ratio [HR] 1.48, 95% CI: 1.24-1.77), with a significant dose-response relationship between MAKE risk and (trend p < 0.001). Subgroup analysis revealed that the negative effect of area socioeconomic deprivation was more pronounced among patients with lower levels of health insurance coverage (resident medical insurance/Self-pay) (interaction p = 0.032). Mediation analysis indicated that the delay between discharge and the first outpatient follow-up mediated approximately 23.2% of the area socioeconomic deprivation effect.
CONCLUSION: Area socioeconomic deprivation is a key socioenvironmental determinant of outcome in AKI patients. This finding suggests a significant association of macrolevel social environments on disease outcomes. Therefore, social environment assessments should be integrated into AKI clinical management systems for systematically reducing health inequalities.