Introduction: Chronic kidney disease (CKD) is greatly affected by social determinants of health. Whether low educational attainment is associated with incident CKD in young adults is unclear. Methods: We evaluated the association of education with incident CKD in 3139 Coronary Artery Risk Development in Young Adults participants. We categorized education into low (high school and less), medium (college), and high (master's and professional studies) groups. Incident CKD was defined as new development of estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m2 or urine albumin to creatinine ratio (ACR) ≥30 mg/g. Change in eGFR over 20 years was a secondary outcome. Results: At baseline, mean age was 35.0 ± 3.6 years, 47% were Black, and 55% were women. Participants with lower educational attainment were less likely to have high income and health insurance and to engage in a healthy lifestyle. Over 20 years, 407 participants developed CKD (13%). Compared with individuals with low educational attainment, those with medium and high educational attainment had an unadjusted hazard ratios for CKD of 0.79 (95% confidence interval [CI] 0.65–0.97) and 0.44 (95% CI, 0.30–0.63), respectively. This association was no longer significant after adjusting for income, health insurance, lifestyle, and health status. Low educational attainment was significantly associated with a change in eGFR in crude and adjusted analyses, although the association was attenuated in the multivariable models (low: –0.83 [95% CI, –0.91 to –0.75], medium: –0.80 (95% CI, –0.95 to –0.64), and high: –0.70 (95% CI, –0.89 to –0.52) ml/min per 1.73 m2 per yr). Conclusions: Health care access, lifestyle, and comorbid conditions likely help explain the association between low educational attainment and incident CKD in young adults.
Bibliographical noteFunding Information:
The Coronary Artery Risk Development in Young Adults study is conducted and supported by the National Heart, Lung, and Blood Institute in collaboration with the University of Alabama at Birmingham (Grant Nos. HHSN268201800005I and HHSN268201800007I ), Northwestern University ( HHSN268201800003I ), University of Minnesota ( HHSN268201800006I ) and Kaiser Foundation Research Institute (Grant No. HHSN268201800004I ). The manuscript was reviewed by CARDIA for scientific content.
This work was supported by the George M. O’Brien Kidney Research Center at Northwestern University (Grant No. P30DK114857 ) from the National Institute of Diabetes and Digestive and Kidney Diseases. TI is supported by Grant K24HL150235 from the National Heart, Lung, and Blood Institute.
- chronic kidney disease
- educational attainment
- socioeconomic status
PubMed: MeSH publication types
- Journal Article