Introduction: African Americans (AA) suffer disproportionately from chronic kidney disease (CKD) and its sequelae. Persons with prevalent CKD or those at risk (i.e., those with diabetes and/or hypertension [HTN]) are at markedly greater risk for incident cardiovascular disease (CVD) compared to patients without these conditions. This association is independent of traditional demographic and clinical risk factors. A growing body of evidence suggests that social determinants, such as socioeconomic and psychosocial factors, impact health. Little data exists on the impact of these factors in the development of CVD among individuals with CKD.
Objective: Quantify the association between socioeconomic and psychosocial factors and risk of CVD events among individuals with or at risk for CKD in the Jackson Heart Study (JHS), a prospective study of AA men and women from Jackson, Mississippi.
Methods: We identified participants with prevalent diabetes, HTN and/or CKD (i.e., presence of albuminuria or glomerular filtration rate <60 mL/min per 1.73 m2) at baseline. Participants with missing covariate/outcome data or prevalent CVD at baseline were excluded. Measures of social determinants of health included socioeconomic (education, occupation, family income) and psychosocial (perceived discrimination, John Henryism, anger, spirituality, religiosity, hostility, pessimism) factors. The outcome of interest was incident CVD defined as a fatal coronary heart disease event, definite or probable myocardial infarction, a cardiac procedure, or a definite/probable stroke. Cox proportional hazards regression was used to determine the risk of incident CVD.
Results: Of the 5301 participants, 3468 (65%) had diabetes, HTN and/or CKD at baseline. Of these, 536 were excluded for history of CVD at baseline and 1357 people were excluded for incomplete covariate/outcome information. Of the 1,575 participants in the analysis, 68% were female, 58% were obese, and 29% were current/former smokers with a mean age of 58 years. Over a median follow-up of 8 years, 128 (8%) had an incident CVD event. In models adjusted for baseline demographic and clinical covariates, socioeconomic and most psychosocial factors were not associated with incident CVD. Individuals with lower self-reported participation in organized religion had a lower risk of CVD events compared to individuals with greater participation in organized religion (HR=0.74, 95% CI: 0.57-0.97). Individuals with lower levels of spirituality had a marginally lower risk of incident CVD compared to those with greater spirituality (HR=0.95, 95% CI: 0.90-1.01).
Conclusions: Many social and psychosocial factors were not associated with CVD. Our findings contrast with prior studies that report religious participation is associated with reduced adverse health outcomes, suggesting further study of the impact of these factors among African Americans is needed.