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Open Access Research article

The association between race and income on risk of mortality in patients with moderate chronic kidney disease

Stacey A Fedewa1*, William M McClellan12, Suzanne Judd3, Orlando M Gutiérrez34 and Deidra C Crews56

Author Affiliations

1 Department of Epidemiology, Emory University, Claudia Nance Rollins Building, 3rd Floor, 1518 Clifton Road, NE, Atlanta, GA 30322, USA

2 Department of Medicine, Emory University, Atlanta, GA, USA

3 Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA

4 Department of Medicine and Division of Nephrology, University of Alabama Birmingham, Birmingham, AL, USA

5 Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA

6 Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA

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BMC Nephrology 2014, 15:136  doi:10.1186/1471-2369-15-136

Published: 23 August 2014

Abstract

Background

Socioeconomic status (SES) is independently associated with chronic kidney disease (CKD) progression; however, its association with other CKD outcomes is unclear. In particular, the potential differential effect of SES on mortality among blacks and whites is understudied in CKD. We aimed to examine survival among individuals with prevalent CKD by income and race in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study.

Methods

We examined 2,761 participants with prevalent CKD stage 3 or 4 between 2003 and 2007 in the REGARDS cohort. Participants were followed through March 2013. Mortality from any cause was assessed by income and race (black or white). Low income was defined as an annual household income < $20,000, and was compared to higher incomes (≥$20,000). Cox proportional hazards models adjusted for age, gender, education, insurance, CKD stage, comorbidity and county-level poverty were used to estimate hazard ratios (HR) and 95% confidence intervals (CI).

Results

A total of 750 deaths (27.5%) occurred during the follow-up period. Average follow-up time was 6.6 years among those alive and 3.7 years among those who died. Low income participants had an elevated adjusted hazard of mortality (HR = 1.58, 95% CI 1.24-2.00) compared to higher income participants. Low income was associated with all-cause mortality regardless of race (HR 1.53; 95% CI 1.18-1.99 among blacks and HR 1.38; 95% CI 1.10-1.74 among whites), with no significant statistical interaction between household income and race (p-value = 0.634). However, black participants had a higher adjusted hazard of mortality (HR = 1.30, 95% CI 1.02-1.65) compared to whites, which was independent of income.

Conclusion

Income was associated with increased mortality for both blacks and whites with CKD. Blacks with CKD had higher mortality than whites even after adjusting for important socio-demographic and clinical factors.