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SES, Chronic Kidney Disease, and Race in the U.S.: A Systematic Review and Meta-analysis

  • Priya Vart
    Correspondence
    Address correspondence to: Priya Vart, PhD, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 2024 East Monument Street, Baltimore MD 21205.
    Affiliations
    Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands

    Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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  • Sander K.R. van Zon
    Affiliations
    Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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  • Ron T. Gansevoort
    Affiliations
    Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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  • Ute Bültmann
    Affiliations
    Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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  • Sijmen A Reijneveld
    Affiliations
    Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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      Context

      The risk of chronic kidney disease (CKD) in the U.S. is higher in individuals with low SES than in those with high SES. However, differences in these risks between African Americans and whites are unclear.

      Evidence acquisition

      Studies published through August 30, 2016 in Medline and EMBASE were searched. From the seven studies (1,775,267 participants) that met inclusion criteria, association estimates were pooled by race in meta-analysis. The ratio of association estimates and the corresponding 95% CIs for African Americans and whites were also pooled in meta-analysis. Additionally, meta-regression analysis was used to explore whether race is related to the strength of SES−CKD association. The analysis was conducted in September 2016.

      Evidence synthesis

      The risk of CKD in low-SES people was 58% higher in African Americans (relative risk=1.58, 95% CI=1.33, 1.84) and 91% higher in whites (relative risk=1.91, 95% CI=1.47, 2.35) compared with their high-SES counterparts. The relative risk of CKD in low SES (versus high SES) was lower in African Americans than in whites (relative risk ratio=0.71, 95% CI=0.65, 0.77). Results from meta-regression analyses also indicated that race is potentially related to the strength of the association between low SES and CKD (p for difference between whites and African Americans=0.001).

      Conclusions

      The risk of CKD in low SES (versus high SES) is higher in whites than in African Americans.
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