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Chronic kidney disease among adult participants of the ELSA-Brasil cohort: association with race and socioeconomic position
  1. Sandhi M Barreto1,
  2. Roberto M Ladeira1,2,
  3. Bruce B Duncan3,
  4. Maria Ines Schmidt3,
  5. Antonio A Lopes4,
  6. Isabela M Benseñor5,
  7. Dora Chor6,
  8. Rosane H Griep7,
  9. Pedro G Vidigal1,
  10. Antonio L Ribeiro1,
  11. Paulo A Lotufo5,
  12. José Geraldo Mill8
  1. 1Medical School & Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
  2. 2Department of Health, Belo Horizonte, Brazil
  3. 3Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
  4. 4Department of Internal Medicine, Universidade Federal da Bahia, Salvador, Brazil
  5. 5Center for Clinical and Epidemiologic Research, Universidade de São Paulo, São Paulo, Brazil
  6. 6National School of Public Health, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
  7. 7Laboratory of Health and Environment Education, Fundação Oswaldo Cruz, Brazil
  8. 8Department of Physiological Sciences, Universidade Federal do Espírito Santo, Brazil
  1. Correspondence to Professor Sandhi M Barreto, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Alfredo Balena 190, Belo Horizonte CEP 30320050 Brazil; sbarreto{at}medicina.ufmg.br

Abstract

Background There is increased interest in understanding why chronic kidney disease (CKD) rates vary across races and socioeconomic groups. We investigated the distribution of estimated glomerular filtration rate (eGFR), urinary albumin–creatinine ratio (ACR) and CKD according to these factors in Brazilian adults.

Methods Using baseline data (2008–2010) of 14 636 public sector employees (35–74 years) enrolled in the Brazilian Longitudinal Study of Adult Health (ELSA)-Brasil multicentre cohort, we estimated the prevalence of CKD by sex, age, race and socioeconomic factors. CKD was defined as ACR≥30 mg/g and/or eGFR<60 mL/min/1.73 m2. GFR was estimated by CKD epidemiology collaboration without correction for race. We used logistic regression to estimate the association of race and socioeconomic position (education, income, social class and occupational nature) with CKD after adjusting for sex, age and several health-related factors.

Results The prevalence of high ACR or low eGFR, in isolation and combined, increased with age, and was higher in individuals with lower socioeconomic position and among black individuals and indigenous individuals. The overall prevalence of CKD was 8.9%. After full adjustments, it was similar in men and women (OR=0.90; 95% CI 0.79 to 1.02) and increased with age (OR=1.07; 95% CI 1.06 to 1.08). Compared to white individuals, black individuals (OR=1.23; 95% CI 1.03 to 1.47), ‘pardos’ (OR=1.16; 95% CI 1.00 to 1.35) and Indigenous (OR=1.72; 95% CI 1.07 to 2.76) people had higher odds for CKD. Having high school (OR=1.15; 95% CI 1.00 to 1.34) or elementary education (OR=1.23; 95% CI 1.03 to 1.47) increased the odds for CKD compared to those having a university degree.

Conclusions There were marked discrepancies in the increases in reduced eGFR and high ACR with age and race. The higher prevalences of CKD in individuals with lower educational status and in non-whites were not explained by differences in health-related factors.

  • RENAL
  • SOCIAL INEQUALITIES
  • AGEING
  • AVOIDABLE DEATHS
  • CHRONIC DI

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