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Associations between socioeconomic status and chronic kidney disease: a meta-analysis
  1. Xiaoxi Zeng1,2,
  2. Jing Liu1,
  3. Sibei Tao1,
  4. Hyokyoung G Hong3,
  5. Yi Li4,
  6. Ping Fu1,2
  1. 1 Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
  2. 2 West China Biomedical Big Data Center, Sichuan University, Chengdu, China
  3. 3 Department of Statistics and Probability, Michigan State University, East Lansing, Michigan, USA
  4. 4 Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to Professor Ping Fu, Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, Sichuan 610041, China; fupinghx{at}


Background Socioeconomic status (SES) has long been conjectured to be associated with the incidence and progression of chronic kidney disease (CKD), but few studies have examined this quantitatively. This meta-analysis aims to fill this gap.

Methods A systematic literature review was performed using Medline and EMBASE to identify observational studies on associations between SES and incidence and progression of CKD, published between 1974 and March 2017. Individual results were meta-analysed using a random effects model, in line with Meta-analysis of Observational Studies in Epidemiology guidelines.

Results In total, 43 articles met our inclusion criteria. CKD prevalence was associated with several indicators of SES, particularly lower income (OR 1.34, 95% CI (1.18 to 1.53), P<0.001; I2=73.0%, P=0.05); lower education (OR 1.21, 95% CI (1.11 to 1.32), P<0.001; I2=45.20%, P=0.034); and lower combined SES (OR 2.18, 95% CI (1.64 to 2.89), P<0.001; I2=0.0%, P=0.326). Lower levels of income, occupation and combined SES were also significantly associated with progression to end-stage renal disease (risk ratio (RR) 1.24, 95% CI (1.12 to 1.37), P<0.001; I2=66.6%, P=0.006; RR 1.05, 95% CI (1.01 to 1.09), P=0.012; I2=0.0%, P=0.796; and RR 1.39, 95% CI (1.09 to 1.79), P=0.009; I2=74.2%, P=0.009). Subgroup analyses generally confirmed these results, except in a few cases, such as an inverse association related to particular socioeconomic backgrounds and where results were adjusted by more disease-related risk factors.

Conclusion Lower income was most closely associated with prevalence and progression of CKD, and lower education was significantly associated with its prevalence. Evidence for other indicators was inconclusive.

  • socioeconomic status
  • epidemiology of chronic non-communicable diseases
  • health inequalities

Statistics from


  • XZ and JL contributed equally.

  • Contributors XZ and JL conceived the study. JL and ST extracted the data. XZ, JL and HGH analysed the results and drafted the manuscript. HGH and YL assisted with the statistical analyses and edited the manuscript. YL and PF refined the study design and contributed to supervision. Each author contributed important intellectual content during the manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved.

  • Funding This work was partially supported by the international cooperation project (2016HH0069) funded by the Science and Technology Department of Sichuan Province, China.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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