The impact of social disadvantage in moderate-to-severe chronic kidney disease

An equity-focused systematic review

Rachael Morton, Iryna Schlackow, Borislava Mihaylova, Natalie D Staplin, Alastair Gray, Alan Cass

    Research output: Contribution to journalReview articleResearchpeer-review

    Abstract

    It is unclear whether a social gradient in health outcomes exists for people with moderate-to-severe chronic kidney disease (CKD). We critically review the literature for evidence of social gradients in health and investigate the 'suitability' of statistical analyses in the primary studies. In this equity-focused systematic review among adults with moderate-to-severe CKD, factors of disadvantage included gender, race/ethnicity, religion, education, socio-economic status or social capital, occupation and place of residence. Outcomes included access to healthcare, kidney disease progression, cardiovascular events, all-cause mortality and suitability of analyses. Twenty-four studies in the pre-dialysis population and 34 in the dialysis population representing 8.9 million people from 10 countries were included. In methodologically suitable studies among pre-dialysis patients, a significant social gradient was observed in access to healthcare for those with no health insurance and no home ownership. Low income and no home ownership were associated with higher cardiovascular event rates and higher mortality [HR 1.94, 95% confidence interval (CI) 1.27-2.98; HR 1.28, 95% CI 1.04-1.58], respectively. In methodologically suitable studies among dialysis patients, females, ethnic minorities, those with low education, no health insurance, low occupational level or no home ownership were significantly less likely to access cardiovascular healthcare than their more advantaged dialysis counterparts. Low education level and geographic remoteness were associated with higher cardiovascular event rates and higher mortality (HR 1.54, 95% CI 1.01-2.35; HR 1.21, 95% CI 1.08-1.37), respectively. Socially disadvantaged pre-dialysis and dialysis patients experience poorer access to specialist cardiovascular health services, and higher rates of cardiovascular events and mortality than their more advantaged counterparts.
    Original languageEnglish
    Pages (from-to)46-56
    Number of pages11
    JournalNephrology Dialysis Transplantation
    Volume31
    Issue number1
    DOIs
    Publication statusPublished - 2016

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    Chronic Renal Insufficiency
    Dialysis
    Ownership
    Confidence Intervals
    Mortality
    Health Insurance
    Delivery of Health Care
    Education
    Health
    Kidney Diseases
    Religion
    Vulnerable Populations
    Occupations
    Population
    Health Services
    Disease Progression
    Economics

    Cite this

    Morton, Rachael ; Schlackow, Iryna ; Mihaylova, Borislava ; Staplin, Natalie D ; Gray, Alastair ; Cass, Alan. / The impact of social disadvantage in moderate-to-severe chronic kidney disease : An equity-focused systematic review. In: Nephrology Dialysis Transplantation. 2016 ; Vol. 31, No. 1. pp. 46-56.
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    abstract = "It is unclear whether a social gradient in health outcomes exists for people with moderate-to-severe chronic kidney disease (CKD). We critically review the literature for evidence of social gradients in health and investigate the 'suitability' of statistical analyses in the primary studies. In this equity-focused systematic review among adults with moderate-to-severe CKD, factors of disadvantage included gender, race/ethnicity, religion, education, socio-economic status or social capital, occupation and place of residence. Outcomes included access to healthcare, kidney disease progression, cardiovascular events, all-cause mortality and suitability of analyses. Twenty-four studies in the pre-dialysis population and 34 in the dialysis population representing 8.9 million people from 10 countries were included. In methodologically suitable studies among pre-dialysis patients, a significant social gradient was observed in access to healthcare for those with no health insurance and no home ownership. Low income and no home ownership were associated with higher cardiovascular event rates and higher mortality [HR 1.94, 95{\%} confidence interval (CI) 1.27-2.98; HR 1.28, 95{\%} CI 1.04-1.58], respectively. In methodologically suitable studies among dialysis patients, females, ethnic minorities, those with low education, no health insurance, low occupational level or no home ownership were significantly less likely to access cardiovascular healthcare than their more advantaged dialysis counterparts. Low education level and geographic remoteness were associated with higher cardiovascular event rates and higher mortality (HR 1.54, 95{\%} CI 1.01-2.35; HR 1.21, 95{\%} CI 1.08-1.37), respectively. Socially disadvantaged pre-dialysis and dialysis patients experience poorer access to specialist cardiovascular health services, and higher rates of cardiovascular events and mortality than their more advantaged counterparts.",
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    The impact of social disadvantage in moderate-to-severe chronic kidney disease : An equity-focused systematic review. / Morton, Rachael; Schlackow, Iryna; Mihaylova, Borislava; Staplin, Natalie D; Gray, Alastair; Cass, Alan.

    In: Nephrology Dialysis Transplantation, Vol. 31, No. 1, 2016, p. 46-56.

    Research output: Contribution to journalReview articleResearchpeer-review

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    T1 - The impact of social disadvantage in moderate-to-severe chronic kidney disease

    T2 - An equity-focused systematic review

    AU - Morton, Rachael

    AU - Schlackow, Iryna

    AU - Mihaylova, Borislava

    AU - Staplin, Natalie D

    AU - Gray, Alastair

    AU - Cass, Alan

    PY - 2016

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    N2 - It is unclear whether a social gradient in health outcomes exists for people with moderate-to-severe chronic kidney disease (CKD). We critically review the literature for evidence of social gradients in health and investigate the 'suitability' of statistical analyses in the primary studies. In this equity-focused systematic review among adults with moderate-to-severe CKD, factors of disadvantage included gender, race/ethnicity, religion, education, socio-economic status or social capital, occupation and place of residence. Outcomes included access to healthcare, kidney disease progression, cardiovascular events, all-cause mortality and suitability of analyses. Twenty-four studies in the pre-dialysis population and 34 in the dialysis population representing 8.9 million people from 10 countries were included. In methodologically suitable studies among pre-dialysis patients, a significant social gradient was observed in access to healthcare for those with no health insurance and no home ownership. Low income and no home ownership were associated with higher cardiovascular event rates and higher mortality [HR 1.94, 95% confidence interval (CI) 1.27-2.98; HR 1.28, 95% CI 1.04-1.58], respectively. In methodologically suitable studies among dialysis patients, females, ethnic minorities, those with low education, no health insurance, low occupational level or no home ownership were significantly less likely to access cardiovascular healthcare than their more advantaged dialysis counterparts. Low education level and geographic remoteness were associated with higher cardiovascular event rates and higher mortality (HR 1.54, 95% CI 1.01-2.35; HR 1.21, 95% CI 1.08-1.37), respectively. Socially disadvantaged pre-dialysis and dialysis patients experience poorer access to specialist cardiovascular health services, and higher rates of cardiovascular events and mortality than their more advantaged counterparts.

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