摘要：Objectives. We sought to determine whether an elevated burden of chronic kidney disease is found among disadvantaged groups living in the United States, Australia, and Thailand. Methods. We used data on participants 35 years or older for whom a valid serum creatinine measurement was available from studies in the United States, Thailand, and Australia. We used logistic regression to analyze the association of income, education, and employment with the prevalence of chronic kidney disease (estimated glomerular filtration rate<60 mL/min/1.73 m2). Results. Age- and gender-adjusted odds of having chronic kidney disease were increased 86% for US Whites in the lowest income quartile versus the highest quartile (odds ratio [OR] = 1.86; 95% confidence interval [CI] = 1.27, 2.72). Odds were increased 2 times and 6 times, respectively, among unemployed (not retired) versus employed non-Hispanic Black and Mexican American participants (OR=2.89; 95% CI=1.53, 5.46; OR=6.62; 95% CI=1.94, 22.64. respectively). Similar associations were not evident for the Australian or Thai populations. Conclusions. Higher kidney disease prevalence among financially disadvantaged groups in the United States should be considered when chronic kidney disease prevention and management strategies are created. This approach is less likely to be of benefit to the Australian and Thai populations. Chronic kidney disease refers to a chronic, irreversible loss of kidney function, ranging from asymptomatic kidney damage to end-stage kidney disease (ESKD), in which death would occur without renal replacement therapy. Principal risk factors include diabetes and hypertension. 1 Loss of kidney function usually takes place gradually over many years. Whether an individual develops ESKD depends on the type of primary kidney disease, how well it is managed, and other risk factors and comorbidities. Most people with chronic kidney disease will die of a comorbid condition, usually cardiovascular disease, before experiencing complete kidney failure requiring dialysis or transplantation. 2 However, the onset and progression of chronic kidney disease are highly preventable, and early treatment of complications can significantly improve long-term patient outcomes. 3 There is strong evidence that low socioeconomic status (SES) is associated with elevated rates of cardiovascular morbidity and mortality. 4 – 6 Recent reports have observed similar associations between SES and the prevalence and progression of chronic kidney disease, 7 – 10 suggesting the existence of an unrecognized group at risk for ESKD and cardiovascular complications of chronic kidney disease. However, it is difficult to assess whether we can generalize these findings beyond the few countries for which data are available or beyond high-income countries. Environmental and infectious causes of chronic kidney disease 11 disproportionately affect the poor of low- and middle-income countries. Combined with a growing prevalence of vascular risk factors accompanying epidemiological transitions 12 and inequities in access to medical services, this may result in a similar excess burden of chronic kidney disease among the disadvantaged populations of these countries; but this remains largely unexplored. Population representative datasets, including data on kidney damage, are now available for Australia, from the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab), and Thailand, from the International Collaborative Study of Cardiovascular Disease in Asia (InterASIA). We analyzed data from these 2 studies, conducted during 1999–2001 and 2000 respectively, alongside US data from the third National Health and Nutrition Examination Survey (NHANES III). 13 – 15 We hypothesized that the association between disadvantage and elevated rates of chronic kidney disease observed for the US population would also be observed in Australia. We also hypothesized that we would see a similar association for the Thai population, despite differing levels of economic development. Relative advantage versus disadvantage was defined in terms of categories of income, educational attainment, and employment status and explored for its association with chronic kidney disease. There is currently an international call for primary and secondary prevention of chronic kidney disease, particularly in developing regions in which resources are lacking to sustain expensive dialysis and transplant services. 16 Understanding the relation between SES and chronic kidney disease may help to define new population groups at risk and identify important barriers to disease detection and appropriate management; this information would have implications for the design of preventive interventions and for health service planning and delivery. We sought to determine whether associations between socioeconomic disadvantage and chronic kidney disease are consistent across high-income countries and whether such relations exist outside high-income countries.
