MP728SOCIOECONOMIC MARKERS IN INCIDENT DIALYSIS PATIENTS: ARE DISADVANTAGED POPULATIONS AT HIGHER RISK TO INITIATE DIALYSIS?

Abstract

INTRODUCTION AND AIMS: In Brazil, nearly 72% of all deaths are attributed to non-communicable diseases (NCDs). Socioeconomic disparities are suspected to play an important role in the development of NCDs. Previous studies suggested that lower socioeconomic conditions as low educational levels can result in a lower compliance to prescriptions and sustained unhealthy lifestyle habits. In spite of that, there is still much to be studied regarding the development of CKD in disadvantaged populations. Therefore, this study aimed to investigate socioeconomic markers in patients at the initiation of the hemodialysis therapy living in Brazil. METHOD(S): This study consisted of a convenience sample of patients living at Contagem, Minas Gerais, Brazil. Patients were interviewed at the local Nephrology Commission from April 2007 to December 2016. The research protocol consisted in a clinical and a socioeconomic assessment by a nephrologist and a social worker, both performed at the time of the initiation hemodialysis or up to 6 months after starting the therapy. A structured questionnaire was used to direct the interview of both professionals and to store the collected data. The records we analyzed with focus on the socioeconomic characteristics and the patient clinical history for hypertension, diabetes mellitus, diabetic retinopathy, peripheral arterial disease, stroke, myocardial infarction, heart failure, amputations, blindness, depression, deafness and cancer. Patients were stratified according to their educational level in two groups: < 4 and >= 4 years of formal education. For the declared monthly income the following groups were considered: = US$280.00 and = US$560.00. Dichotomous variables were compared by the Chi-square test with a level of significance p <0.05 using the software STATA 14.2. RESULT(S): The city of Contagem (600,000 inhabitants, average per capita income $300.00; 21% of the population < 4 years of study) is located in the metropolitan area of Belo Horizonte, the capital of the State of Minas Gerais. 386 patients on hemodialysis were interviewed (mean age 58.83 +/- 15.12 years; 52.1% male). 73.8% were retired, 23.8% unemployed, and only 2.3% employed. The distribution of the declared monthly family income (2.7 persons per family, on average) was: 35.5% = US$280.00 and = US$560.00. Hypertension and diabetes mellitus were highly prevalent (84.5% and 40.2%). There was no statistical significant difference for prevalence of the comorbidities through the subgroups. Since our sample is small these results might reflect the lack of power of this study. In spite of that, there was an elevated frequency of patients with < 4 years of formal education (245; 63.5%) and with a monthly family income below US$560.00 (329; 85.2%) when compared with the local population general socioeconomic parameters. CONCLUSION(S): There was no statistical association between the prevalence of comorbidities and socioeconomic factors in the group of patients analyzed. However, it was possible to identify a higher rate of patients with < 4 years of formal education and a monthly per capita income below US$560.00 initiating hemodialysis. This suggest that disadvantaged populations might be at elevated risk to initiate dialysis in our location. Further studies with larger samples are necessary to define the role of routine socioeconomic assessment as a tool to understand the possible factors involved in the progression to chronic kidney failure in developing countries.