Background

Disadvantaged socioeconomic position (SEP) is an important predictor of poor health in children with chronic kidney disease (CKD). The time course over which SEP influences the health of children with CKD and their carers is unknown.

Methods

This prospective longitudinal study included 377 children, aged 6–18 years with CKD (stages I–V, dialysis, and transplant), and their primary carers. Mixed effects ordinal regression was performed to assess the association between SEP and carer-rated child health and carer self-rated health over a 4-year follow-up.

Results

Adjusted for CKD stage, higher family household income (adjusted odds ratio (OR) (95% CI) 3.3, 1.8–6.0), employed status of primary carers (1.7, 0.9–3.0), higher carer-perceived financial status (2.6, 1.4–4.8), and carer home ownership (2.2, 1.2–4.0) were associated with better carer-rated child health. Household income also had a differential effect on the carer’s self-rated health over time (p = 0.005). The predicted probabilities for carers’ overall health being ‘very good’ among lower income groups at 0, 2, and 4 years were 0.43 (0.28–0.60), 0.34 (0.20–0.51), and 0.25 (0.12–0.44), respectively, and 0.81 (0.69–0.88), 0.84 (0.74–0.91), and 0.88 (0.76–0.94) for carers within the higher income group.

Conclusions

Carers and their children with CKD in higher SEP report better overall child and carer health compared with those in lower SEP. Carers of children with CKD in low-income households had poorer self-rated health compared with carers in higher-income households at baseline, and this worsened over time. These cumulative effects may contribute to health inequities between higher and lower SEP groups over time.

中文翻译：

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慢性肾病儿童及其照顾者的社会经济地位与整体健康状况之间的纵向关联

背景

弱势社会经济地位（SEP）是慢性肾病（CKD）儿童健康状况不佳的重要预测因素。SEP 影响 CKD 儿童及其照顾者健康的时间进程尚不清楚。

方法

这项前瞻性纵向研究纳入了 377 名 6-18 岁 CKD 儿童（I-V 期、透析和移植）及其主要照顾者。进行混合效应序数回归以评估 SEP 与护理者评价的儿童健康和护理者自评健康在 4 年随访期间的关联。

结果

根据 CKD 阶段进行调整，家庭收入较高（调整后优势比 (OR) (95% CI) 3.3, 1.8–6.0），主要护理人员的就业状况（1.7, 0.9–3.0），护理人员感知的财务状况较高（2.6, 1.4-4.8）和看护者拥有住房（2.2、1.2-4.0）与看护者评价的儿童健康状况更好相关。随着时间的推移，家庭收入对护理人员的自评健康也有不同的影响（p  = 0.005）。低收入群体在 0、2 和 4 岁时护理人员整体健康状况“非常好”的预测概率分别为 0.43 (0.28–0.60)、0.34 (0.20–0.51) 和 0.25 (0.12–0.44)。对于高收入组的照顾者，为 0.81 (0.69–0.88)、0.84 (0.74–0.91) 和 0.88 (0.76–0.94)。

结论

与 SEP 较低的护理人员及其患有 CKD 的孩子相比，SEP 较高的护理人员及其子女的儿童和护理人员总体健康状况更好。与高收入家庭的照顾者相比，低收入家庭中 CKD 儿童的照顾者的自评健康状况较差，而且随着时间的推移，情况会恶化。随着时间的推移，这些累积效应可能会导致较高和较低 SEP 群体之间的健康不平等。