2 research outputs found
The impact of social disadvantage in moderate-to-severe chronic kidney disease: an equity-focused systematic review
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, allcause 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