Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Apr 10;79(5):366-372.
doi: 10.1136/jech-2024-222370.

Syndemic approach to chronic kidney disease, cardiovascular disease and educational level: a longitudinal cohort study in northwest Italy

Lucia Dansero  1 , Lorenzo Milani  2 , Roberto Gnavi  3 , Alessandra Macciotta  2   4 , Cinzia Destefanis  2 , Winston Gilcrease  2 , Savino Sciascia #  5 , Fulvio Ricceri #  2
Affiliations

Syndemic approach to chronic kidney disease, cardiovascular disease and educational level: a longitudinal cohort study in northwest Italy

Lucia Dansero et al. J Epidemiol Community Health. .

Abstract

Introduction: Chronic kidney disease (CKD) and end-stage renal disease (ESRD) represent significant public health challenges, linked to an elevated risk of cardiovascular disease (CVD) and influenced by socioeconomic disparities. This longitudinal study investigates the interplay between socioeconomic position (SEP), measured as educational level, CKD/ESRD and CVD using the syndemic framework.

Methods: We used data from the Piedmont Longitudinal Study to establish CKD and ESRD cohorts and to identify incident CVD between January 2013 and December 2017. The educational level was retrieved from census data. We applied an accelerated failure time model to explore the relationships between CKD/ESRD, CVD and educational level with all-cause mortality and emergency room (ER) acuity.

Results: The CKD cohort included 44 220 individuals, with 12 341 deaths and 15 440 ER admissions. The ESRD cohort included 4021 subjects, experiencing 1303 deaths and 1640 ER admissions. After adjusting for confounders, the combination of CKD, low educational level and incident CVD was associated with increased all-cause mortality (time ratios (TR) 0.07, 95% CI 0.05 to 0.08) and ER acuity (TR 0.16, 95% CI 0.14 to 0.17) compared with those with higher education. Instead, patients with ESRD with incident CVD and high educational level had the highest increase in mortality (TR 0.08, 95% CI 0.05 to 0.14) and ER acuity (TR 0.20, 95% CI 0.1 to 0.30).

Conclusions: Patients with CKD with low educational levels and incident CVD may represent a 'syndemic', associated with higher mortality and ER acuity. Our study highlights a potential link between these conditions and socioeconomic disparities, suggesting the need for multifaceted approaches.

Keywords: CARDIOVASCULAR DISEASES; COHORT STUDIES; EPIDEMIOLOGY; Health inequalities.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1. Results from the accelerated failure time model using generalised gamma distribution for the CKD cohort and ESRD cohort stratified by sex. CKD, chronic kidney disease; CVD, cardiovascular disease; ESRD, end-stage renal disease.; ER, emergency room; SEP, socioeconomic position.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Matsushita K, Ballew SH, Coresh J, et al. Measures of chronic kidney disease and risk of incident peripheral artery disease: a collaborative meta-analysis of individual participant data. Lancet Diabetes Endocrinol. 2017;5:718–28. doi: 10.1016/S2213-8587(17)30183-3. - DOI - PMC - PubMed
    1. Jha V, Garcia-Garcia G, Iseki K, et al. Chronic kidney disease: global dimension and perspectives. The Lancet . 2013;382:260–72. doi: 10.1016/S0140-6736(13)60687-X. - DOI - PubMed
    1. Bikbov B, Purcell CA, Levey AS, et al. Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2020;395:709–33. doi: 10.1016/S0140-6736(20)30045-3. - DOI - PMC - PubMed
    1. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases USRDS annual data report: epidemiology of kidney disease in the united states. 2022
    1. Gansevoort RT, Correa-Rotter R, Hemmelgarn BR, et al. Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and prevention. The Lancet . 2013;382:339–52. doi: 10.1016/S0140-6736(13)60595-4. - DOI - PubMed