Kidney Week

Abstract: FR-PO1030

Associations of Income Variability and Incident ESKD in Diabetes: A Population-Based Cohort Study

Session Information

• Social, Environmental, and Economic Determinants of Kidney Health
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Diversity and Equity in Kidney Health

• 900 Diversity and Equity in Kidney Health

Authors

• Kang, Min Woo, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)

Min Woo Kang

• Park, Sehoon, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)

Sehoon Park, MD, PhD

• Kim, Dong Ki, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)

Dong Ki Kim, MD, PhD

• Kim, Yong Chul, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)

Yong Chul Kim, MD, PhD

• Oh, Kook-Hwan, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)

Kook-Hwan Oh, MD, PhD

• Lee, Jinsun, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)

Jinsun Lee

Background

Studies analyzing the association between income variability and incident end-stage kidney disease(ESKD) among individuals with type 2 diabetes(T2D) are limited.

Methods

Based on data from the Korean National Health Insurance Service, 1,481,371 adults aged 30-64 with no history of kidney disease were identified among individuals with T2D who underwent health checkups from 2015 to 2016. Annual income levels from the preceding 4 years to the baseline year were categorized into four quartiles. Income parameters were analyzed in three aspects: (1) cumulative number of years belonging to a specific income status quartile, (2) income volatility, and (3) changes in income status between the initial and end points during the observation. The primary outcome was defined as the first occurrence of incident ESKD, followed up until December 31, 2020. Cox proportional hazard models were used to estimate hazard ratios(HRs) and 95% confidence intervals(CIs).

Results

Persistent low income status over 5 years was associated with an increased risk of ESKD (HR 5years vs. 0years: 1.54, 95% CI 1.33-1.78; Ptrend<0.0001). High income volatility was associated with an increased risk of ESKD (HR highest vs. lowest quartile: 1.43, 95% CI 1.27-1.60; Ptrend<0.001). Irrespective of initial income status, individuals whose income status declined during the 5 years of observation, comparing between the initial and end points, had an increased risk of ESKD. The increase in ESKD risk was most pronounced among those whose income status declined steeply from the highest to the lowest quartile (HR steepest decline vs. unchanged: 1.58, 95% CI 1.19-2.09; Ptrend=0.0025).

Conclusion

Among adults aged 30–64 with T2D, individuals with more persistent low income status, higher income volatility, and steeper income decline had a significantly increased risk of ESKD.

Funding

• Government Support – Non-U.S.