M DIDSBURY1,2, A VAN ZWIETEN1,2, K CHEN1,2, L JAMES1,2, A FRANCIS2,3, S KIM1,2, G WILLIAMS1,2, K HOWARD2, S MCTAGGART3, A WALKER4, F MACKIE5, T KARA6, N NASSAR2, A TEIXEIRA-PINTO1,2, A TONG1,2, JC CRAIG1,2, G WONG1,2,7
1Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales; 2Sydney School of Public Health, The University of Sydney, New South Wales; 3Child and Adolescent Renal Service, Children’s Health Queensland; 4Department of Renal Medicine, The Royal Children’s Hospital, Melbourne, Victoria 5Department of Nephrology, Sydney Children’s Hospital at Randwick, Sydney, New South Wales; 6Department of Nephrology, Starship Children’s Hospital, Auckland, New Zealand; 7Centre for Transplant and Renal Research, Westmead Hospital, Sydney, New South Wales
Aim: In children with chronic kidney disease (CKD), we aimed to assess the impact of low socioeconomic status (SES) on overall health, and to identify the mediators of any association observed.
Background: Striking disparities in health by SES exist in children without CKD. The relationship between SES and health, and the factors that contribute to the health disparities by SES in children with CKD are unknown.
Methods: Between 2012 and 2017, 377 children aged 6-18 years with CKD [stage 1-5 (n=200), dialysis (n=42), transplant (n=135)] were recruited from five paediatric units across Australia and New Zealand. We used adjusted logistic regression to assess the association between SES and self-rated health status, and mediation analyses to determine variables that mediated the SES and health relationship.
Results: The median ages of caregivers and children were 42.3 (interquartile range (IQR) 9.7) and 12.1 (6.6) years. Approximately 50% of households earned less than the population median income, with 41% of primary caregivers being unemployed. Lower SES, defined as lower income group [adjusted OR (95%CI): 3.62 (1.81-7.68)], financial hardship [3.26 (1.58-6.70)] and unemployment [3.40 (1.51-6.12)], was associated with poorer self-rated health in children with CKD (I-V) but not in those receiving dialysis or after transplant (p interaction = 0.001). Over 50% of the relationship between SES and poor health was mediated by co-morbidities including chronic infections and growth impairment, while 30% of the overall effect was mediated by poor parental health (Sobel p = 0.04).
Conclusions: Lower SES is associated with poor health in children with CKD stages I-V. Modifiable factors including comorbid conditions of the child and caregivers contribute significantly to the association between low SES and poor health.