Influence of race, ethnicity and socioeconomic status on kidney disease

Abstract

Low socioeconomic status (SES) influences disease incidence and contributes to poor health outcomes throughout an individual's life course across a wide range of populations. Low SES is associated with increased incidence of chronic kidney disease, progression to end-stage renal disease, inadequate dialysis treatment, reduced access to kidney transplantation, and poor health outcomes. Similarly, racial and ethnic disparities, which in the USA are strongly associated with lower SES, are independently associated with poor health outcomes. In this Review, we discuss individual-level and group-level SES factors, and the concomitant role of race and ethnicity that are associated with and mediate the development of chronic kidney disease, progression to end-stage renal disease and access to treatment.

Figure 1

Multilevel framework of health disparities in patients with kidney disease. Racial and socioeconomic factors influence the development and treatment of CKD during the course of an individual's life. Genetic predisposition influences the development of CKD and may interact with individual-level socioeconomic factors such as education, income and health literacy. Environmental and community-level factors, such as neighbourhood poverty, diet, racial segregation and access to health care, influence the life course and treatment of CKD in addition to individual-level socioeconomic factors. Abbreviations: CKD, chronic kidney disease; ESRD, end-stage renal disease; SES, socioeconomic status.