Kidney Week

Abstract: PUB228

Incident CKD among Canadian Immigrants: A Population-Based Cohort Study

Session Information

• Publication Only

Category: Diversity and Equity in Kidney Health

• 900 Diversity and Equity in Kidney Health

Authors

• Hundemer, Gregory L., Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

Gregory L. Hundemer, MD, MPH

• Olaye, Ida-Ehosa I., University of Ottawa, Ottawa, Ontario, Canada

Ida-Ehosa I. Olaye

• Akbari, Ayub, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

Ayub Akbari, MD, MS, MSc, FASN

• Sood, Manish M., Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

Manish M. Sood, MD, MS, FASN

Background

A “healthy immigrant effect” has been demonstrated for a number of chronic health conditions including cardiovascular disease, diabetes, and dementia; however, the link between immigrant status and chronic kidney disease (CKD) remains uncertain. We sought to compare the risk for incident CKD among Canadian immigrants and non-immigrants.

Methods

We conducted a population level, observational cohort study of adult Ontario residents, including foreign-born immigrant Canadian citizens and non-immigrant Canadian citizens by birth, with normal baseline kidney function (outpatient estimated glomerular filtration rate [eGFR] ≥70 mL/min/1.73m²) between 2007-2020 utilizing provincial health administrative data. We used multivariable Cox proportional hazard regression modeling to evaluate the relationship between immigrant status and incident CKD (outpatient eGFR <60 mL/min/1.73m²).

Results

The study cohort included 10,440,210 Ontario residents, consisting of 22% immigrants and 78% non-immigrants. The mean (SD) age and eGFR were 45 (17) years and 102 (16) mL/min/1.73m², respectively, and 54% of individuals were female. A total of 117,028 immigrants (5%, 7 events per 1000 person years) and 984,277 non-immigrants (12%, 16 events per 1000 person years) developed incident CKD during follow-up. Immigrants experienced a 20% lower adjusted risk for incident CKD compared to non-immigrants (adjusted hazard ratio [HR] 0.80 [95% confidence interval [CI] 0.80-0.81]) - see Figure. Both refugee immigrants (adjusted HR 0.87 [95% CI 0.86-0.89]) and non-refugee immigrants (adjusted HR 0.79 [95% CI 0.79-0.80]) experienced a lower risk for incident CKD compared to non-immigrants.

Conclusion

Immigrants experience a lower risk for incident CKD compared to non-immigrants. These findings provide evidence of a “healthy immigrant effect” in relation to kidney health.

Adjusted Cumulative Incidence Curves for Chronic Kidney Disease among Immigrants Versus Non-Immigrants.