Social determinants of health and chronic kidney disease in United States adults: A cross-sectional study from National Health and Nutrition Examination Survey 2003-2018.

OBJECTIVE

To explore the association between social determinants of health (SDoH) and chronic kidney disease (CKD) prevalence and prognosis in the US population.

METHODS

Data were sourced from the US National Health and Nutrition Examination Survey 2003-2018, including 32,389 participants aged ≥20 years. Unfavorable SDoH included unemployment, low income, food insecurity, low education, lack of healthcare access, lack of health insurance, housing instability, and not being married or living with a partner. CKD prevalence and poor prognosis were the primary outcomes. A cumulative SDoH score assessed the overall association with CKD, while individual scores were examined for their independent associations. Multivariable logistic regression, restricted cubic splines, and subgroup analysis were conducted.

RESULTS

Cumulative SDoH scores were associated with CKD prevalence (OR = 1.14, 95 %CI: 1.11-1.16) and poor prognosis (OR = 1.17, 95 %CI: 1.12-1.22). A nonlinear relationship existed between Cumulative SDoH scores and prevalence, while the association with prognosis was linear. Unemployment (OR = 1.13, 95 %CI: 1.01-1.27), low income (OR = 1.38, 95 %CI: 1.25-1.52), low education (OR = 1.15, 95 %CI: 1.05-1.27), lack of health insurance (OR = 1.11, 95 %CI: 1.01-1.21), housing instability (OR = 1.17, 95 %CI: 1.05-1.29), and not married nor living with a partner (OR = 1.12, 95 %CI: 1.01-1.25) were associated with prevalence. Unemployment (OR = 1.42, 95 %CI: 1.16-1.74), low income (OR = 1.48, 95 %CI: 1.28-1.71), low education (OR = 1.19, 95 %CI: 1.04-1.38), and housing instability (OR = 1.42, 95 %CI: 1.23-1.66) were associated with poor prognosis.

CONCLUSIONS

Unfavorable SDoH are positively associated with both CKD prevalence and poor prognosis.