The association between socioeconomic disparities and left ventricular hypertrophy in chronic kidney disease: results from the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD)

Eunjeong Kang, Joongyub Lee, Hyo Jin Kim, Miyeun Han, Soo Wan Kim, Kyu-Beck Lee, Suah Sung, Tae-Hyun Yoo, Wookyung Chung, Curie Ahn, Kook-Hwan Oh, Eunjeong Kang, Joongyub Lee, Hyo Jin Kim, Miyeun Han, Soo Wan Kim, Kyu-Beck Lee, Suah Sung, Tae-Hyun Yoo, Wookyung Chung, Curie Ahn, Kook-Hwan Oh

Abstract

Background: Left ventricular hypertrophy (LVH) is one of the risk factors for cardiovascular (CV) disease and mortality. However, the relationship between socioeconomic status (SES) and LVH in chronic kidney disease remains unclear.

Methods: Data were collected from the KoreaN Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD, NCT01630486 at http://www.clinicaltrials.gov ). Subjects with CKD and aged ≥50 were included. SES was characterized based on monthly income and educational attainment, each of which was divided into three strata. LVH was defined as LV mass/height2.7 ≥ 47 g/m2.7 in female and ≥ 50 g/m2.7 in male. Age, sex, diabetes, CKD stage, body mass index, blood pressure and physical activity were included as covariates.

Results: A total of 1361 patients were included. Mean age was 60.9 ± 6.9 years, and 63.2% were men. Higher education level was associated with higher monthly income (P for trend < 0.001). The lowest education level was independently associated with LVH (lower than high school, adjusted odds ratio [OR] 1.485, 95% CI 1.069-2.063, P = 0.018; completed high school, adjusted OR 1.150, 95% confidence interval [CI] 0.834-1.584, P = 0.394; highest education level as the reference). Monthly income level was marginally associated with LVH after adjusting for covariates ($1500-4500, adjusted OR 1.230, 95% CI 0.866-1.748, P = 0.247; < $1500, adjusted OR 1.471, 95% CI 1.002-2.158, P = 0.049; > $4500; reference).

Conclusions: In the CKD population, lower SES, defined by educational attainment and low income level exhibited a significant association with LVH, respectively. Longitudinal follow-up will reveal whether lower SES is associated with poor CKD outcomes.

Keywords: Chronic kidney disease; Education; Income; Left ventricular hypertrophy; Socioeconomic status.

Conflict of interest statement

Ethics approval and consent to participate

Ethics approval obtained from the Institutional Review Board at each participating clinical center — i.e., Seoul National University Hospital (1104–089-359), Seoul National University Bundang Hospital (B-1106/129–008), Yonsei University Severance Hospital (4–2011-0163), Kangbuk Samsung Medical Center (2011–01-076), Seoul St. Mary’s Hospital (KC11OIMI0441), Gil Hospital (GIRBA2553), Eulji General Hospital (201105–01), Chonnam National University Hospital (CNUH-2011-092), and Pusan Paik Hospital (11–091) in 2011. Written informed consent was obtained from the participants.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study Flow. Abbreviations: SES, socioeconomic status; LV, left ventricular
Fig. 2
Fig. 2
Odds Ratio for LVH according to SES in Univariate Analysis. Abbreviations: LVH, left ventricular hypertrophy; SES, socioeconomic status; USD, US dollar. *: P < 0.005
Fig. 3
Fig. 3
Odds Ratio for LVH according to SES in Multivariate Analysis. Adjusted for age, sex, mean arterial pressure, diabetes, CKD stage, physical activity Abbreviations: LVH, left ventricular hypertrophy; SES, socioeconomic status; CKD, chronic kidney disease; USD, US dollar. *: P 

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