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Sarah L. White, MPH, Kevin McGeechan, MBiostat, Michael Jones, PhD, Alan Cass, PhD, FRACP, Steven J. Chadban, PhD, FRACP, Kevan R. Polkinghorne, FRACP, Vlado Perkovic, PhD, FRACP and Paul J. Roderick, MD, FRCP

Sarah L. White, Alan Cass, and Vlado Perkovic are with the George Institute, Sydney, Australia, and the Central Clinical School, University of Sydney, Sydney. Kevin McGeechan is with the School of Public Health, University of Sydney, Sydney. At the time of the study, Michael Jones was with the School of Public Health, University of Sydney, Sydney. Steven J. Chadban is with Royal Prince Alfred Hospital, Sydney, and the Central Clinical School, University of Sydney, Sydney. Kevan R. Polkinghorne is with Monash Medical Centre, Melbourne, Australia. Paul J. Roderick is with the University of Southampton, Southampton, England.

Correspondence: Requests for reprints should be sent to Sarah L. White, The George Institute, PO Box M201, Missenden Road, Sydney, NSW 2050, Australia (e-mail: swhite{at}george.org.au).

Objectives. We sought to determine whether an elevated burden of chronic kidney disease is found among disadvantaged groups living in the United States, Australia, and Thailand.

Methods. We used data on participants 35 years or older for whom a valid serum creatinine measurement was available from studies in the United States, Thailand, and Australia. We used logistic regression to analyze the association of income, education, and employment with the prevalence of chronic kidney disease (estimated glomerular filtration rate<60 mL/min/1.73 m²).

Results. Age- and gender-adjusted odds of having chronic kidney disease were increased 86% for US Whites in the lowest income quartile versus the highest quartile (odds ratio [OR] = 1.86; 95% confidence interval [CI] = 1.27, 2.72). Odds were increased 2 times and 6 times, respectively, among unemployed (not retired) versus employed non-Hispanic Black and Mexican American participants (OR=2.89; 95% CI=1.53, 5.46; OR=6.62; 95% CI=1.94, 22.64. respectively). Similar associations were not evident for the Australian or Thai populations.

Conclusions. Higher kidney disease prevalence among financially disadvantaged groups in the United States should be considered when chronic kidney disease prevention and management strategies are created. This approach is less likely to be of benefit to the Australian and Thai populations.