Lifecourse Socioeconomic Status and Kidney Disease

University Of North Carolina Chapel Hill, Chapel Hill NC

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Abstract

[unreadable] DESCRIPTION (provided by applicant): Although the prevalence of chronic kidney disease (CKD) is growing in the United States, it remains an under-recognized and under-treated condition. While many risk factors have been studied in relation to CKD, an understanding of the high frequency of CKD in African Americans is incomplete. In particular, the literature on socioeconomic status (SES) and CKD remains sparse. It has been suggested that individual and contextual level SES over a life course are more robust measures than the commonly used static definitions of SES. We propose 1) to examine the relation of individual SES at birth and across life course with kidney function decline and with CKD using cumulative, trajectory and categorical models of SES; 2) to examine the role of biological and social attributes, such as blood pressure, diabetes, dyslipidemia, access to healthcare, and social support, as mediators of an association between SES and kidney function decline and chronic kidney disease, and 3) to examine contextual SES at birth and across the life course as both an independent risk factor and effect modifier of the association between individual-level SES measures and risk of kidney function decline and chronic kidney disease. We propose to conduct these analyses on extant data from 12,681 middle-aged men and women (3227 African Americans) examined by the Atherosclerosis Risk in Communities (ARIC) Study in1987-89, and followed since then {94% completeness of follow-up of survivors). Comprehensive SES information (both individual and contextual level) from birth through adulthood was collected on this cohort by the ARIC [unreadable] Life Course SES study. Glomerular filtration rate and its change over 9-12 years of follow-up will be estimated from serum creatinine, and diagnosed kidney disease (as well as comorbidity) during a 14-16 year study period will be assessed from extant abstracted hospital records. A variety of pertinent covariates and health indicators such as age, blood pressure, blood chemistries, type 2 diabetes, smoking and hyperlipidemia were collected at baseline and at triennial reexaminations. Valuable new, information on the effects of SES across life course on chronic kidney disease and on putative intervening mechanisms that are amenable to preventive and therapeutic approaches will be ascertained. [unreadable] [unreadable] [unreadable]