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Longitudinal associations between socioeconomic position and overall health of children with chronic kidney disease and their carers

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Abstract

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.

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Acknowledgements

We would like to thank all the patients and their families who participated in and supported this study.

Author information

Authors and Affiliations

  1. Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia

    Chandana Guha, Anita van Zwieten, Siah Kim, Madeleine Didsbury, Armando Teixeira-Pinto, Kirsten Howard, Martin Howell, Allison Jaure, Alison Hayes, Rakhee Raghunandan, Kylie-Ann Mallitt & Germaine Wong

  2. Centre for Kidney Research, Kids Research Institute, The Children’s Hospital at Westmead, Sydney, NSW, Australia

    Rashmi Shingde, Chandana Guha, Anita van Zwieten, Siah Kim, Armando Teixeira-Pinto, Allison Jaure, Kylie-Ann Mallitt & Germaine Wong

  3. Royal Children’s Hospital, Melbourne, Australia

    Amanda Walker

  4. School of Medicine, University of Queensland, Brisbane, Australia

    Anna Francis & Steven McTaggart

  5. Child and Adolescent Renal Service, Queensland Children’s Hospital, Brisbane, Australia

    Anna Francis & Steven McTaggart

  6. Starship Children’s Hospital, Auckland, New Zealand

    Chanel Prestidge

  7. Department of Health Services Research and Policy, Australian National University, Canberra, Australia

    Emily Lancsar

  8. Sydney Children’s Hospital, Randwick, Australia

    Fiona Mackie

  9. School of Women’s and Child Health, University of New South Wales, Kensington, Australia

    Fiona Mackie

  10. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England

    Joseph Kwon & Stavros Petrou

  11. Menzies Centre for Health Policy & Economics, School of Public Health, University of Sydney, Sydney, Australia

    Kirsten Howard, Martin Howell & Rakhee Raghunandan

  12. School of Psychology, University of Sydney, Sydney, NSW, Australia

    Suncica Lah

  13. College of Medicine and Public Health, Flinders University, Adelaide, Australia

    Jonathan C. Craig

Authors
  1. Rashmi Shingde
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  2. Chandana Guha
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  5. Amanda Walker
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  11. Fiona Mackie
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  15. Allison Jaure
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  16. Alison Hayes
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  19. Suncica Lah
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  20. Steven McTaggart
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  21. Jonathan C. Craig
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  23. Germaine Wong
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Contributions

Research idea and study design: RS, AVZ, GW, KM; data analysis/interpretation: RS, AVZ, CG, SK, GW, KM; statistical analysis: RS, GW, KM; manuscript drafting and revisions: RS, CG, AVZ, SK, AW, AF, JK, KH, MH, AJ, AH, RR, SP, SL, SM, JCC, KM, GW; manuscript supervision: GW, KM.

Corresponding author

Correspondence to Rashmi Shingde.

Ethics declarations

Ethics approval and consent to participate

This study was approved by the Human Research Ethics Committees (HRECs) of all participating centres (The Children’s Hospital at Westmead and Sydney Children’s Hospital (HREC/12/SCHN/159), Lady Cilento Children’s Hospital (HREC/12/QCRH/113), The Royal Children’s Hospital (Royal Children’s Hospital Human Research Ethics Committee: 33229), and Starship Children’s Hospital (New Zealand Health and Disability Ethics Committees: 15/NTB/37)). Written informed consent (or assent depending on participant age) was obtained from all participants and/or carers.

Conflict of interest

The authors declare no competing interests.

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Kylie-Ann Mallitt and Germaine Wong are co-senior authors.

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Shingde, R., Guha, C., van Zwieten, A. et al. Longitudinal associations between socioeconomic position and overall health of children with chronic kidney disease and their carers. Pediatr Nephrol 39, 1533–1542 (2024). https://doi.org/10.1007/s00467-023-06236-x

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  • DOI: https://doi.org/10.1007/s00467-023-06236-x

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