Letter to the Editor
Social disparities, risk factors and chronic kidney disease
Disparidad social, factores de riesgo y enfermedad renal crónica
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Ludivina Robles-Osorio, Ernesto Sabath" "autores" => array:2 [ 0 => array:3 [ "nombre" => "M. Ludivina" "apellidos" => "Robles-Osorio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Ernesto" "apellidos" => "Sabath" "email" => array:1 [ 0 => "esabath@yahoo.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Facultad de Ciencias Naturales, Universidad Autónoma de Querétaro, Querétaro, Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Nefrología, Servicios de Salud del Estado de Querétaro, Querétaro, Mexico" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Disparidad social, factores de riesgo y enfermedad renal crónica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1166 "Ancho" => 2449 "Tamanyo" => 110727 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pathophysiological mechanisms linking low socioeconomic status, psychosocial factors and the development of CKD.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The term “health disparities” refers to those differences in health status experienced by different demographic groups that occur in the context of social or economic inequality. Health disparities affect access to services and quality of care, which is reflected by the increase in the morbidity and mortality of chronic diseases.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In countries where medical care for chronic kidney disease (CKD) is not universal, treatment for this disease represents a devastating medical, social and economic problem for patients and their families; thus, the costs of treating this disease are considered as “catastrophic health expenditures.” A catastrophic health expenditure can be defined as one where the whole family spends more than 30% of their income to pay for the family's healthcare.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In industrialised countries, CKD disproportionately affects socially disadvantaged groups, such as ethnic minorities and people with a low socioeconomic income.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> Multiple studies conducted in the United States and Canada have shown a strong association between low socioeconomic status and higher incidence and prevalence and more complications related to CKD. Crews et al.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a> showed that people with a lower socioeconomic status had a 59% greater risk of developing CKD. This association was higher in the black population. Also, residence in poor neighbourhoods was found to be strongly associated with an increased prevalence of CKD.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In Europe, the relationship between socioeconomic status and CKD has been less studied; however, studies in Sweden, the UK and France have also found this association.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Unfortunately, there are few studies in industrialising countries like India and Mexico. In these countries, there is a high prevalence of the disease in the socioeconomically disadvantaged population.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> In Central America, particularly in Nicaragua and El Salvador, there have been reports of a new kidney condition called Mesoamerican nephropathy, which occurs mainly in poor workers who toil in suboptimal working conditions at extreme ambient temperatures and experience long periods of dehydration.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Poverty also adversely affects some of the most important social determinants of health, such as developing healthy habits, getting healthcare in a timely manner and suffering environmental exposure to nephrotoxic agents such as lead, cadmium and arsenic (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">A higher prevalence of births with low birth weight promotes not only less development in terms of renal mass but also an increased risk of hypertension and CKD; the association of post-streptococcal GN with CKD has also been reported as a risk factor in some populations. Depression, anxiety and increased exposure to addictions also promote the activation of the sympathetic nervous system and an increased release of cytokines that can directly influence the pathogenesis of kidney damage (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">An increased intake of sodium, sweetened beverages and foods with phosphorus has also been reported in this population. In addition, the chances of receiving proper treatment to slow the progression of kidney damage are lower in this population.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">A clearer understanding of the situations of vulnerable populations and risk factors in people in the lower socioeconomic strata might allow for designing better public health measures to reduce the burden of kidney disease in this population, since growth of national income per capita does not necessarily mean that the poorest members of society get better access to quality health services.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Further studies in industrialising countries and studies that provide more information about the pathophysiological mechanisms by which poverty is associated with a higher prevalence of CKD are needed.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Robles-Osorio ML, Sabath E. Disparidad social, factores de riesgo y enfermedad renal crónica. Nefrologia. 2016;36:577–579.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1166 "Ancho" => 2449 "Tamanyo" => 110727 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pathophysiological mechanisms linking low socioeconomic status, psychosocial factors and the development of CKD.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Source</span>: Adapted from García-García and Jha.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a></p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Health behaviour \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Access to healthcare \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Biological factors \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Environmental factors \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lack of information on preventive measures \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lack of access \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Low birth weight \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Exposure to nephrotoxic agents, e.g. Pb, As and Cd \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lack of knowledge of how to deal with the disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Geographic distance to health centres \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Genetic predisposition \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Increased exposure to infectious diseases \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Unhealthy habits \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Catastrophic health expenditure (“out of pocket”) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Inadequate nutrition \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lack of safe drinking water and proper sanitation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Unhealthy work, long hours in the sun and low hydration levels \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Less control of chronic diseases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1299538.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Main mechanisms by which poverty leads to the development of chronic kidney disease.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Spec No. 80-94" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Social conditions as fundamental causes of disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.G. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 4 | 7 |
| 2024 October | 71 | 61 | 132 |
| 2024 September | 63 | 49 | 112 |
| 2024 August | 74 | 70 | 144 |
| 2024 July | 47 | 40 | 87 |
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| 2024 May | 77 | 39 | 116 |
| 2024 April | 74 | 44 | 118 |
| 2024 March | 54 | 35 | 89 |
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| 2024 January | 84 | 21 | 105 |
| 2023 December | 41 | 25 | 66 |
| 2023 November | 86 | 44 | 130 |
| 2023 October | 88 | 47 | 135 |
| 2023 September | 57 | 21 | 78 |
| 2023 August | 68 | 25 | 93 |
| 2023 July | 82 | 21 | 103 |
| 2023 June | 83 | 21 | 104 |
| 2023 May | 92 | 29 | 121 |
| 2023 April | 92 | 30 | 122 |
| 2023 March | 143 | 19 | 162 |
| 2023 February | 84 | 25 | 109 |
| 2023 January | 90 | 35 | 125 |
| 2022 December | 93 | 41 | 134 |
| 2022 November | 79 | 39 | 118 |
| 2022 October | 81 | 44 | 125 |
| 2022 September | 68 | 38 | 106 |
| 2022 August | 87 | 41 | 128 |
| 2022 July | 59 | 41 | 100 |
| 2022 June | 67 | 56 | 123 |
| 2022 May | 145 | 46 | 191 |
| 2022 April | 92 | 50 | 142 |
| 2022 March | 87 | 50 | 137 |
| 2022 February | 69 | 40 | 109 |
| 2022 January | 106 | 34 | 140 |
| 2021 December | 111 | 58 | 169 |
| 2021 November | 98 | 31 | 129 |
| 2021 October | 470 | 49 | 519 |
| 2021 September | 116 | 36 | 152 |
| 2021 August | 158 | 41 | 199 |
| 2021 July | 64 | 44 | 108 |
| 2021 June | 90 | 41 | 131 |
| 2021 May | 101 | 69 | 170 |
| 2021 April | 247 | 114 | 361 |
| 2021 March | 159 | 50 | 209 |
| 2021 February | 102 | 47 | 149 |
| 2021 January | 93 | 25 | 118 |
| 2020 December | 60 | 12 | 72 |
| 2020 November | 71 | 28 | 99 |
| 2020 October | 68 | 26 | 94 |
| 2020 September | 58 | 22 | 80 |
| 2020 August | 76 | 31 | 107 |
| 2020 July | 54 | 18 | 72 |
| 2020 June | 80 | 23 | 103 |
| 2020 May | 86 | 19 | 105 |
| 2020 April | 85 | 28 | 113 |
| 2020 March | 84 | 23 | 107 |
| 2020 February | 87 | 41 | 128 |
| 2020 January | 80 | 32 | 112 |
| 2019 December | 94 | 38 | 132 |
| 2019 November | 94 | 27 | 121 |
| 2019 October | 92 | 19 | 111 |
| 2019 September | 146 | 27 | 173 |
| 2019 August | 128 | 27 | 155 |
| 2019 July | 138 | 33 | 171 |
| 2019 June | 107 | 23 | 130 |
| 2019 May | 107 | 32 | 139 |
| 2019 April | 173 | 40 | 213 |
| 2019 March | 120 | 40 | 160 |
| 2019 February | 69 | 33 | 102 |
| 2019 January | 97 | 25 | 122 |
| 2018 December | 273 | 46 | 319 |
| 2018 November | 336 | 13 | 349 |
| 2018 October | 296 | 20 | 316 |
| 2018 September | 150 | 21 | 171 |
| 2018 August | 114 | 17 | 131 |
| 2018 July | 123 | 11 | 134 |
| 2018 June | 117 | 12 | 129 |
| 2018 May | 65 | 16 | 81 |
| 2018 April | 74 | 7 | 81 |
| 2018 March | 93 | 9 | 102 |
| 2018 February | 55 | 6 | 61 |
| 2018 January | 60 | 6 | 66 |
| 2017 December | 62 | 7 | 69 |
| 2017 November | 82 | 8 | 90 |
| 2017 October | 43 | 5 | 48 |
| 2017 September | 62 | 10 | 72 |
| 2017 August | 72 | 5 | 77 |
| 2017 July | 64 | 6 | 70 |
| 2017 June | 50 | 8 | 58 |
| 2017 May | 60 | 7 | 67 |
| 2017 April | 43 | 9 | 52 |
| 2017 March | 26 | 6 | 32 |
| 2017 February | 38 | 5 | 43 |
| 2017 January | 38 | 9 | 47 |
| 2016 December | 24 | 3 | 27 |
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