Faculty Collaboration Database

The cumulative impact of social determinants of health factors on mortality in adults with diabetes and chronic kidney disease. BMC Nephrol 2021 Feb 28;22(1):76

Date

03/01/2021

Pubmed ID

33639878

Pubmed Central ID

PMC7916298

DOI

10.1186/s12882-021-02277-2

Scopus ID

2-s2.0-85101833757 (requires institutional sign-in at Scopus site)   20 Citations

Abstract

BACKGROUND: A growing body of evidence supports the potential role of social determinants of health on health outcomes. However, few studies have examined the cumulative effect of social determinants of health on health outcomes in adults with chronic kidney disease (CKD) with or without diabetes. This study examined the cumulative impact of social determinants of health on mortality in U.S. adults with CKD and diabetes.

METHODS: We analyzed data from National Health and Nutrition Examination Surveys (2005-2014) for 1376 adults age 20 and older (representing 7,579,967 U.S. adults) with CKD and diabetes. The primary outcome was all-cause mortality. CKD was based on estimated glomerular filtration rate and albuminuria. Diabetes was based on self-report or Hemoglobin A1c of ≥6.5%. Social determinants of health measures included family income to poverty ratio level, depression based on PHQ-9 score and food insecurity based on Food Security Survey Module. A dichotomous social determinant measure (absence vs presence of ≥1 adverse social determinants) and a cumulative social determinant score ranging from 0 to 3 was constructed based on all three measures. Cox proportional models were used to estimate the association between social determinants of health factors and mortality while controlling for covariates.

RESULTS: Cumulative and dichotomous social determinants of health score were significantly associated with mortality after adjusting for demographics, lifestyle variables, glycemic control and comorbidities (HR = 1.41, 95%CI 1.18-1.68 and HR = 1.41, 95%CI 1.08-1.84, respectively). When investigating social determinants of health variables separately, after adjusting for covariates, depression (HR = 1.52, 95%CI 1.10-1.83) was significantly and independently associated with mortality, however, poverty and food insecurity were not statistically significant.

CONCLUSIONS: Specific social determinants of health factors such as depression increase mortality in adults with chronic kidney disease and diabetes. Our findings suggest that interventions are needed to address adverse determinants of health in this population.

Author List

Ozieh MN, Garacci E, Walker RJ, Palatnik A, Egede LE

Authors

Leonard E. Egede MD Center Director, Chief, Professor in the Medicine department at Medical College of Wisconsin
Mukoso Nwamaka Ozieh MD Assistant Professor in the Medicine department at Medical College of Wisconsin
Anna Palatnik MD Associate Professor in the Obstetrics and Gynecology department at Medical College of Wisconsin
Rebekah Walker PhD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Cross-Sectional Studies
Diabetes Mellitus
Diabetic Nephropathies
Female
Humans
Male
Middle Aged
Renal Insufficiency, Chronic
Social Determinants of Health
United States
Young Adult