The effect of renal insufficiency on workforce participation in the United States: an analysis using National Health and Nutrition Examination Survey III data

Abstract

Background: End-stage renal disease is associated with workforce nonparticipation, but no previous study has assessed the impact of renal insufficiency on employment status from a population standpoint.

Methods: To determine whether renal insufficiency is independently associated with labor force participation, an analysis was performed using observational data from the Third National Health and Nutrition Examination Survey, which represents a cross-sectional sample of the US population. Five thousand five hundred fifty-eight subjects of the civilian noninstitutionalized US population aged 18 to 64 years provided complete information regarding key variables. A logistic regression equation with workforce participation as the dependent variable was created. Explanatory variables included age, sex, race, marital status, census region, and education, as well as the health-state indicators of general health status, presence or absence of diabetes, hypertension, stroke, congestive heart failure, myocardial infarction, and an indicator of renal function. Renal dysfunction was defined by serum creatinine values greater than 1.7 mg/dL (150 micromol/L) for women and greater than 2.0 mg/dL (180 micromol/L) for men.

Results: Renal dysfunction was independently associated with labor force nonparticipation, with an odds ratio of 7.94 (95% confidence interval, 1.60 to 39.43). This relationship remained statistically significant after subjects with markedly elevated serum creatinine levels were excluded.

Conclusion: A previously unrecognized independent association between renal function and labor force participation was identified. This group of patients warrants further attention regarding identification of specific factors leading to nonemployment, potential for workforce rehabilitation, and assessment of the impact of renal insufficiency in other functional spheres.