Association of Educational Attainment with Incidence of Chronic Kidney Disease in Young Adults

Abstract Introduction Chronic kidney disease (CKD) is greatly impacted 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 CARDIA participants. We categorized education into low (high school and below), medium (college), and high (masters and professional studies) groups. Incident CKD was defined as new development of eGFR Results At baseline, the mean age was 35.0 ± 3.6, 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 (13%) developed CKD. Compared to individuals with low educational attainment, those with medium and high educational attainment had an unadjusted hazard ratio (HR) for CKD of 0.79 (95%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 change in eGFR in crude and adjusted analyses, although the association was attenuated in the multivariable models (low: -0.83 [95%CI, -0.91 – -0.75], medium: -0.80 (95%CI,-0.95 – -0.64) and high:-0.70 (95%CI, -0.89 – -0.52) mL/min/1.73 m2/year). Conclusions Health care access, lifestyle, and comorbid conditions likely help explain the association between low educational attainment and incident CKD in young adults.