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Lower Socioeconomic Status and Disability Among US Adults With Chronic Kidney Disease, 1999-2008

Income, education, and race/ethnicity can influence both environmental and individual factors. Environmental factors include available options for diet and physical activity, exposure to toxins, stress (for example, from local crime), and availability of health information. Individual factors include heredity, personal diet and activity choices, psychosocial issues (for example, addiction), and adherence to medications. Each of these factors could contribute to major risk factors for CKD (uncontrolled diabetes and uncontrolled hypertension), directly to CKD, or possibly even directly to disability. Diabetes and hypertension can lead to CKD (and possibly vice versa) and to disability; CKD can contribute to disability (and possibly vice versa). Increased age is a risk factor for CKD, comorbidities that lead to disability (arthritis, cancer), and disability itself. Additionally, complications of CKD (for example, anemia, bone mineral metabolism disorder, cardiovascular disease, and peripheral arterial disease) can lead to disability. Finally, disability can affect income.

Figure. Pathways from socioeconomic and demographic factors to chronic kidney disease and disability. Solid arrows indicate likely paths; dashed arrows indicate possible paths.

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