Individual and neighborhood-level social and deprivation factors impact kidney health in the GLOMMS-CORE study

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

doi:10.1016/j.kint.2024.07.021

Individual and neighborhood-level social and deprivation factors impact kidney health in the GLOMMS-CORE study

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

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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. Here, we linked kidney health and individual census records in the North of Scotland (Grampian area), 2011-2021 (GLOMMS-CORE) and identified incident kidney presentations at thresholds of estimated glomerular filtration rate (eGFR) under 60 (mild/early), under 45 (moderate), under 30 ml/min/1.73m²(advanced), and acute kidney disease (AKD). Household and neighborhood socioeconomic measures, living circumstances, and long-term mortality were compared. Case-mix adjusted multivariable logistic regression (living circumstances), and Cox models (mortality) incorporating an interaction between the household and the neighborhood were used. Among census respondents, there were 48546, 29081, 16116, 28097 incident presentations of each respective eGFR cohort and AKD. Classifications of socioeconomic position by household and neighborhood 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: 95% confidence intervals) of (1.26: 1.19-1.32) and (1.77: 1.60-1.96), respectively with adjustment for neighborhood indices making little difference. Those within either a deprived household or deprived neighborhood experienced greater mortality, but those within both had the poorest outcomes. Unskilled and unemployed households frequently reported being limited by illness, adverse mental health, living alone, basic accommodation, lack of car ownership, language difficulties, visual and hearing impairments. Thus, impacts of deprivation on kidney health are spread throughout society, complex, serious, and not confined to those living in deprived neighborhoods.

Original language	English
Journal	Kidney International
Early online date	11 Aug 2024
DOIs	https://doi.org/10.1016/j.kint.2024.07.021
Publication status	E-pub ahead of print - 11 Aug 2024

Bibliographical note

We acknowledge the support of the Grampian Data Safe Haven (DaSH) facility within the Aberdeen Centre for Health Data Science and the associated financial support of the University of Aberdeen, and NHS Research Scotland (through NHS Grampian investment in DaSH). For more informaTIon, visit the DaSH website: htttp://www.abdn.ac.uk/iahs/facilities/grampian-data-safe-haven.php. The authors would like to acknowledge the support of the eDRIS Team (Public Health Scotland), in particular Fiona James, for their involvement in obtaining approvals, provisioning and linking data
and for the use of the secure analytical platform within the National Safe Haven. This work contains statistical data from the National Records of Scotland (NRS) which is Crown Copyright. The use of NRS statistical data in this work does not imply the endorsement of NRS in relation to the interpretation or analysis of the statistical data. This work uses research datasets which may not exactly reproduce National Statistics aggregates. We are also grateful to Mrs Neerja Jain (Kidney Research UK) and Professor Paul Cockwell (UK Kidney Association) for feedback on the design of the KINDER study.

Data Availability Statement

Data access would require approval by Scotland’s Public Benefit and Privacy Panel for Health, Scotland’s Statistics Public Benefit and Privacy Panel, and appropriate ethical committees. Information on how researchers may make requests to obtain similar datasets from the health research dataset custodians may be provided upon request.

Keywords

Chronic Kidney Disease
Equity
Epidemiology
Health inequalities
Social determinants

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.kint.2024.07.021Licence: CC BY

Cite this

Sawhney, S., Atherton, I., Blakeman, T., Black, C., Cowan, E., Croucher, C., Fraser, S. DS., Hughes, A., Nath, M., Nitsch, D., Scholes-Robertson, N., & Rzewuska Diaz, M. (2024). Individual and neighborhood-level social and deprivation factors impact kidney health in the GLOMMS-CORE study. Kidney International. Advance online publication. https://doi.org/10.1016/j.kint.2024.07.021

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title = "Individual and neighborhood-level social and deprivation factors impact kidney health in the GLOMMS-CORE study",

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. Here, we linked kidney health and individual census records in the North of Scotland (Grampian area), 2011-2021 (GLOMMS-CORE) and identified incident kidney presentations at thresholds of estimated glomerular filtration rate (eGFR) under 60 (mild/early), under 45 (moderate), under 30 ml/min/1.73m2(advanced), and acute kidney disease (AKD). Household and neighborhood socioeconomic measures, living circumstances, and long-term mortality were compared. Case-mix adjusted multivariable logistic regression (living circumstances), and Cox models (mortality) incorporating an interaction between the household and the neighborhood were used. Among census respondents, there were 48546, 29081, 16116, 28097 incident presentations of each respective eGFR cohort and AKD. Classifications of socioeconomic position by household and neighborhood 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: 95% confidence intervals) of (1.26: 1.19-1.32) and (1.77: 1.60-1.96), respectively with adjustment for neighborhood indices making little difference. Those within either a deprived household or deprived neighborhood experienced greater mortality, but those within both had the poorest outcomes. Unskilled and unemployed households frequently reported being limited by illness, adverse mental health, living alone, basic accommodation, lack of car ownership, language difficulties, visual and hearing impairments. Thus, impacts of deprivation on kidney health are spread throughout society, complex, serious, and not confined to those living in deprived neighborhoods.",

keywords = "Chronic Kidney Disease, Equity, Epidemiology, Health inequalities, Social determinants",

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

note = "We acknowledge the support of the Grampian Data Safe Haven (DaSH) facility within the Aberdeen Centre for Health Data Science and the associated financial support of the University of Aberdeen, and NHS Research Scotland (through NHS Grampian investment in DaSH). For more informaTIon, visit the DaSH website: htttp://www.abdn.ac.uk/iahs/facilities/grampian-data-safe-haven.php. The authors would like to acknowledge the support of the eDRIS Team (Public Health Scotland), in particular Fiona James, for their involvement in obtaining approvals, provisioning and linking data and for the use of the secure analytical platform within the National Safe Haven. This work contains statistical data from the National Records of Scotland (NRS) which is Crown Copyright. The use of NRS statistical data in this work does not imply the endorsement of NRS in relation to the interpretation or analysis of the statistical data. This work uses research datasets which may not exactly reproduce National Statistics aggregates. We are also grateful to Mrs Neerja Jain (Kidney Research UK) and Professor Paul Cockwell (UK Kidney Association) for feedback on the design of the KINDER study.",

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T1 - Individual and neighborhood-level social and deprivation factors impact kidney health in the GLOMMS-CORE study

AU - Sawhney, Simon

AU - Atherton, Iain

AU - Blakeman, Thomas

AU - Black, Corri

AU - Cowan, Eilidh

AU - Croucher, Catherine

AU - Fraser, Simon DS

AU - Hughes, Audrey

AU - Nath, Mintu

AU - Nitsch, Dorothea

AU - Scholes-Robertson, Nicole

AU - Rzewuska Diaz, Magdalena

N1 - We acknowledge the support of the Grampian Data Safe Haven (DaSH) facility within the Aberdeen Centre for Health Data Science and the associated financial support of the University of Aberdeen, and NHS Research Scotland (through NHS Grampian investment in DaSH). For more informaTIon, visit the DaSH website: htttp://www.abdn.ac.uk/iahs/facilities/grampian-data-safe-haven.php. The authors would like to acknowledge the support of the eDRIS Team (Public Health Scotland), in particular Fiona James, for their involvement in obtaining approvals, provisioning and linking data and for the use of the secure analytical platform within the National Safe Haven. This work contains statistical data from the National Records of Scotland (NRS) which is Crown Copyright. The use of NRS statistical data in this work does not imply the endorsement of NRS in relation to the interpretation or analysis of the statistical data. This work uses research datasets which may not exactly reproduce National Statistics aggregates. We are also grateful to Mrs Neerja Jain (Kidney Research UK) and Professor Paul Cockwell (UK Kidney Association) for feedback on the design of the KINDER study.

PY - 2024/8/11

Y1 - 2024/8/11

N2 - 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. Here, we linked kidney health and individual census records in the North of Scotland (Grampian area), 2011-2021 (GLOMMS-CORE) and identified incident kidney presentations at thresholds of estimated glomerular filtration rate (eGFR) under 60 (mild/early), under 45 (moderate), under 30 ml/min/1.73m2(advanced), and acute kidney disease (AKD). Household and neighborhood socioeconomic measures, living circumstances, and long-term mortality were compared. Case-mix adjusted multivariable logistic regression (living circumstances), and Cox models (mortality) incorporating an interaction between the household and the neighborhood were used. Among census respondents, there were 48546, 29081, 16116, 28097 incident presentations of each respective eGFR cohort and AKD. Classifications of socioeconomic position by household and neighborhood 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: 95% confidence intervals) of (1.26: 1.19-1.32) and (1.77: 1.60-1.96), respectively with adjustment for neighborhood indices making little difference. Those within either a deprived household or deprived neighborhood experienced greater mortality, but those within both had the poorest outcomes. Unskilled and unemployed households frequently reported being limited by illness, adverse mental health, living alone, basic accommodation, lack of car ownership, language difficulties, visual and hearing impairments. Thus, impacts of deprivation on kidney health are spread throughout society, complex, serious, and not confined to those living in deprived neighborhoods.

AB - 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. Here, we linked kidney health and individual census records in the North of Scotland (Grampian area), 2011-2021 (GLOMMS-CORE) and identified incident kidney presentations at thresholds of estimated glomerular filtration rate (eGFR) under 60 (mild/early), under 45 (moderate), under 30 ml/min/1.73m2(advanced), and acute kidney disease (AKD). Household and neighborhood socioeconomic measures, living circumstances, and long-term mortality were compared. Case-mix adjusted multivariable logistic regression (living circumstances), and Cox models (mortality) incorporating an interaction between the household and the neighborhood were used. Among census respondents, there were 48546, 29081, 16116, 28097 incident presentations of each respective eGFR cohort and AKD. Classifications of socioeconomic position by household and neighborhood 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: 95% confidence intervals) of (1.26: 1.19-1.32) and (1.77: 1.60-1.96), respectively with adjustment for neighborhood indices making little difference. Those within either a deprived household or deprived neighborhood experienced greater mortality, but those within both had the poorest outcomes. Unskilled and unemployed households frequently reported being limited by illness, adverse mental health, living alone, basic accommodation, lack of car ownership, language difficulties, visual and hearing impairments. Thus, impacts of deprivation on kidney health are spread throughout society, complex, serious, and not confined to those living in deprived neighborhoods.

KW - Chronic Kidney Disease

KW - Equity

KW - Epidemiology

KW - Health inequalities

KW - Social determinants

U2 - 10.1016/j.kint.2024.07.021

DO - 10.1016/j.kint.2024.07.021

M3 - Article

C2 - 39142564

SN - 0085-2538

JO - Kidney International

JF - Kidney International

ER -