Social determinants of health and chronic kidney disease in United States adults: A cross-sectional study from National Health and Nutrition Examination Survey 2003-2018.

Objective: To explore the association between social determinants of health (SDoH) and chronic kidney disease (CKD) prevalence and prognosis in the US population. Methods: Data were sourced from the US National Health and Nutrition Examination Survey 2003-2018, including 32,389 participants aged ≥20 years. Unfavorable SDoH included unemployment, low income, food insecurity, low education, lack of healthcare access, lack of health insurance, housing instability, and not being married or living with a partner. CKD prevalence and poor prognosis were the primary outcomes. A cumulative SDoH score assessed the overall association with CKD, while individual scores were examined for their independent associations. Multivariable logistic regression, restricted cubic splines, and subgroup analysis were conducted. Results: Cumulative SDoH scores were associated with CKD prevalence (OR = 1.14, 95 %CI: 1.11-1.16) and poor prognosis (OR = 1.17, 95 %CI: 1.12-1.22). A nonlinear relationship existed between Cumulative SDoH scores and prevalence, while the association with prognosis was linear. Unemployment (OR = 1.13, 95 %CI: 1.01-1.27), low income (OR = 1.38, 95 %CI: 1.25-1.52), low education (OR = 1.15, 95 %CI: 1.05-1.27), lack of health insurance (OR = 1.11, 95 %CI: 1.01-1.21), housing instability (OR = 1.17, 95 %CI: 1.05-1.29), and not married nor living with a partner (OR = 1.12, 95 %CI: 1.01-1.25) were associated with prevalence. Unemployment (OR = 1.42, 95 %CI: 1.16-1.74), low income (OR = 1.48, 95 %CI: 1.28-1.71), low education (OR = 1.19, 95 %CI: 1.04-1.38), and housing instability (OR = 1.42, 95 %CI: 1.23-1.66) were associated with poor prognosis. Conclusions: Unfavorable SDoH are positively associated with both CKD prevalence and poor prognosis.