Individual and neighbourhood-level deprivation, kidney disease, and long-term mortality in the "Core determinants and Equity Grampian Laboratory Outcomes Morbidity and Mortality Study” (GLOMMS-CORE)

Sawhney, Simon; Atherton, Iain; Blakeman, Thomas; Black, Corri; Cowan, Eilidh; Croucher, Catherine; DS Fraser, Simon; Hughes, Audrey; Nath, Mintu; Nitsch, Dorothea; Scholes-Robertson, Nicole; Rzewuska Diaz, Magdalena

Abstract

Prospective cohort studies of kidney equity are limited by a focus on advanced rather than early disease; and selective recruitment. Whole population studies frequently rely on area-level measures of deprivation as opposed to individual measures of social disadvantage.

We linked kidney health and individual census records in the North of Scotland, 2011-2021 (GLOMMS-CORE). We identified incident kidney presentations at thresholds of estimated glomerular filtration rate (eGFR) <60 (mild/early), <45 (moderate), <30 ml/min/1.73m2 (advanced), and acute kidney disease (AKD). We compare household and neighbourhood socioeconomic measures, living circumstances, and long-term mortality. We used case-mix adjusted multivariable logistic regression (for living circumstances), and Cox models (for mortality) incorporating an interaction between household and neighbourhood.

Among 458897 census respondents, there were 48546, 29081, 16116, 28097 incident presentations of eGFR <60, <45, <30 and AKD; mean ages 70-77; 52-55% female. Classifications of socioeconomic position by household and neighbourhood were related but complex, and frequently did not match. Compared to households of “professionals”, people with early kidney disease in “unskilled” or “unemployed” households had increased mortality (adjusted hazard ratios, HR, and 95% confidence intervals, CI: 1.26, 1.19-1.32 and 1.77, 1.60-1.96). Those with either a deprived household or deprived neighbourhood experienced greater mortality, but those with both dimensions had the poorest outcomes. “Unskilled” and “unemployed” households more frequently reported being “limited a lot” by ill health, adverse mental health, living alone, basic accommodation, no car, English language difficulties, visual and hearing impairments.

The impacts of deprivation on kidney health are spread throughout society, complex, serious, and not confined to those living in deprived neighbourhoods.

Citation

Sawhney, S., Atherton, I., Blakeman, T., Black, C., Cowan, E., Croucher, C., DS Fraser, S., Hughes, A., Nath, M., Nitsch, D., Scholes-Robertson, N., & Rzewuska Diaz, M. (online). Individual and neighbourhood-level deprivation, kidney disease, and long-term mortality in the "Core determinants and Equity Grampian Laboratory Outcomes Morbidity and Mortality Study” (GLOMMS-CORE). Kidney International, https://doi.org/10.1016/j.kint.2024.07.021

• Journal Article Type: Article
• Acceptance Date: Jul 11, 2024
• Online Publication Date: Aug 12, 2024
• Deposit Date: Jul 24, 2024
• Publicly Available Date: Aug 12, 2024
• Print ISSN: 0085-2538
• Electronic ISSN: 1523-1755
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1016/j.kint.2024.07.021
• Keywords: Chronic Kidney Disease; Equity; Epidemiology; Health inequalities; Social determinants