Neighborhood Deprivation, Financial Hardship, and Decrements in Kidney Function Across a Decade

TL;DR

Living in deprived neighborhoods and facing financial hardship are linked to faster kidney function decline over 10 years.

Contribution

This study identifies financial hardship as a key pathway linking neighborhood deprivation to accelerated kidney aging.

Findings

High neighborhood deprivation was associated with faster eGFR decline over a decade.

Financial hardship independently predicted faster eGFR decline.

Financial hardship partially explained the link between neighborhood deprivation and kidney function loss.

Abstract

Neighborhood factors are critical determinants of accelerated renal aging, an important risk for chronic kidney disease (CKD), a pressing public health problem. Little is known about whether financial hardship plays an important role as an individual-level pathway in the association between neighborhood factors and accelerated renal aging. This analysis utilized data from 653 (M age = 54, SD = 9.5; 55% female; 79% NH white) participants who completed the biomarker data collections in both wave 2 and 3 of the Midlife in the United States (MIDUS) study. The neighborhood factor is based on the national level Area Deprivation Index (ADI), a validated neighborhood disadvantage score based on neighborhood socioeconomic factors (1=least disadvantage, 100=most disadvantage). Financial hardship includes material (e.g., lower income to poverty ratio), psychological (e.g., perceived difficulty paying bills), and behavioral (e.g., sold possessions to meet needs) domains. The main outcome was absolute change in creatine-based estimated glomerular filtration rate (eGFR) across a decade. Analyses were adjusted for age, sex, education, and health-related factors (smoking, obesity, hypertension, and diabetes status). Participants living in a highly deprived neighborhood (third percentile or higher) showed faster decrements in eGFR (Est=3.05, SE = 1.42, p<.05). Financial hardship was also associated with faster decrements in eGFR (Est=3.74, SE = 1.19, p<.01). Indirect effect analysis indicated that higher financial hardship was significant pathway through which neighborhood deprivation was linked to faster decrements in eGFR (Est=0.92, SE = 0.39, p<.05). Neighborhood deprivation is a critical risk factor for accelerated renal aging, highly likely due to the higher experience of financial hardship.