Prospective cohort studies of kidney equity are limited by a focus on advanced rather than early disease and selective recruitment. Whole population studies frequently rely on area-level measures of deprivation as opposed to individual measures of social disadvantage. Here, we linked kidney health and individual census records in the North of Scotland (Grampian area), 2011-2021 (GLOMMS-CORE) and identified incident kidney presentations at thresholds of estimated glomerular filtration rate (eGFR) under 60 (mild/early), under 45 (moderate), under 30 ml/min/1.73m2 (advanced), and acute kidney disease (AKD). Household and neighborhood socioeconomic measures, living circumstances, and long-term mortality were compared. Case-mix adjusted multivariable logistic regression (living circumstances), and Cox models (mortality) incorporating an interaction between the household and the neighborhood were used. Among census respondents, there were 48546, 29081, 16116, 28097 incident presentations of each respective eGFR cohort and AKD. Classifications of socioeconomic position by household and neighborhood were related but complex, and frequently did not match. Compared to households of professionals, people with early kidney disease in unskilled or unemployed households had increased mortality (adjusted hazard ratios: 95% confidence intervals) of (1.26: 1.19-1.32) and (1.77: 1.60-1.96), respectively with adjustment for neighborhood indices making little difference. Those within either a deprived household or deprived neighborhood experienced greater mortality, but those within both had the poorest outcomes. Unskilled and unemployed households frequently reported being limited by illness, adverse mental health, living alone, basic accommodation, lack of car ownership, language difficulties, and visual and hearing impairments. Thus, impacts of deprivation on kidney health are spread throughout society—complex, serious, and not confined to those living in deprived neighborhoods.

中文翻译：

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在 GLOMMS-CORE 研究中，个人和社区层面的社会和剥夺因素会影响肾脏健康


肾脏公平的前瞻性队列研究受到关注晚期而不是早期疾病和选择性招募的限制。整体人口研究通常依赖于区域层面的剥夺测量，而不是社会劣势的个别测量。在这里，我们将 2011-2021 年苏格兰北部（Grampian 地区）的肾脏健康和个人人口普查记录 （GLOMMS-CORE） 联系起来，并确定了估计肾小球滤过率 （eGFR） 低于 60（轻度/早期）、45 岁以下（中度）、低于 30 ml/min/1.73m2（晚期）和急性肾病 （AKD） 阈值的事件肾脏表现。比较了家庭和社区的社会经济指标、生活环境和长期死亡率。使用病例混合调整的多变量 logistic 回归 （生活环境） 和 Cox 模型 （死亡率），结合家庭与邻里之间的互动。在人口普查受访者中，每个 eGFR 队列和 AKD 分别有 48546、29081、16116、28097 次事件报告。按家庭和社区划分的社会经济地位分类是相关的，但很复杂，并且经常不匹配。与专业人士家庭相比，无技能或失业家庭中的早期肾病患者死亡率 （调整后的风险比： 95% 置信区间） 分别增加 （1.26： 1.19-1.32） 和 （1.77： 1.60-1.96），邻里指数调整几乎没有差异。那些生活在贫困家庭或贫困社区的人死亡率更高，但两者中的人的结果最差。 无技能和失业家庭经常报告受到疾病、不良心理健康、独居、基本住宿、缺乏汽车所有权、语言困难以及视力和听力障碍的限制。因此，剥夺对肾脏健康的影响遍布整个社会——复杂、严重，并且不仅限于生活在贫困社区的人。