Income Level and Impaired Kidney Function Among Working Adults in Japan
Nana Ishimura1, Kosuke Inoue1,2, Shiko Maruyama3
1Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
JAMA Health Forum
|March 1, 2024
Summary
Even with universal health coverage, lower income is linked to higher risks of rapid chronic kidney disease (CKD) progression and kidney replacement therapy. This highlights the need for income-tailored CKD strategies.
Area of Science:
- Nephrology
- Public Health
- Health Economics
Background:
- Chronic kidney disease (CKD) affects 850 million globally, with socioeconomic status (SES) a known risk factor.
- Limited data exists on SES disparities in CKD within universal health coverage systems, such as Japan.
Purpose of the Study:
- To investigate the association between income disparity and the development of impaired kidney function in Japan's working population.
- To identify risks for rapid CKD progression and kidney replacement therapy initiation based on income levels.
Main Methods:
- Nationwide retrospective cohort study of 5,591,060 adults (34-74 years) insured by the Japan Health Insurance Association (2015-2022).
- Analysis of estimated glomerular filtration rate (eGFR) decline and kidney replacement therapy initiation based on 2015 income deciles.
- Adjusted for confounders including sex, age, and diabetes status.
Main Results:
- The lowest income decile showed significantly higher risks for rapid CKD progression (aOR, 1.70) and kidney replacement therapy initiation (aHR, 1.65) compared to the highest income decile.
- This income-based disparity was more pronounced in males and individuals without diabetes.
- The association was observed across all CKD stages (1-5).
Conclusions:
- Income-based disparities in CKD progression and treatment initiation persist even in countries with universal health coverage.
- Findings underscore the necessity of tailoring CKD prevention and management strategies to individual socioeconomic status.
- Addressing income-related inequities is crucial for effective CKD care globally.
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