Relationship between educational and occupational levels, and Chronic Kidney Disease in a multi-ethnic sample- The HELIUS study

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Abstract

Background

Ethnic minority groups in high-income countries are disproportionately affected by Chronic Kidney Disease (CKD) for reasons that are unclear. We assessed the association of educational and occupational levels with CKD in a multi-ethnic population. Furthermore, we assessed to what extent ethnic inequalities in the prevalence of CKD were accounted for by educational and occupational levels.

Methods

Cross-sectional analysis of baseline data from the Healthy Life in an Urban Setting (HELIUS) study of 21,433 adults (4,525 Dutch, 3,027 South-Asian Surinamese, 4,105 African Surinamese, 2,314 Ghanaians, 3,579 Turks, and 3,883 Moroccans) aged 18 to 70 years living in Amsterdam, the Netherlands. Three CKD outcomes were considered using the 2012 KDIGO (Kidney Disease: Improving Global Outcomes) severity of CKD classification. Comparisons between educational and occupational levels were made using logistic regression analyses.

Results

After adjustment for sex and age, low-level and middle-level education were significantly associated with higher odds of high to very high-risk of CKD in Dutch (Odds Ratio (OR) 2.10, 95% C.I., 1.37–2.95; OR 1.55, 95% C.I., 1.03–2.34). Among ethnic minority groups, low-level education was significantly associated with higher odds of high to very-high-risk CKD but only in South-Asian Surinamese (OR 1.58, 95% C.I., 1.06–2.34). Similar results were found for the occupational level in relation to CKD risk.

Conclusion

The lower educational and occupational levels of ethnic minority groups partly accounted for the observed ethnic inequalities in CKD. Reducing CKD risk in ethnic minority populations with low educational and occupational levels may help to reduce ethnic inequalities in CKD and its related complications.

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Most cited references 36

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The utility of 'country of birth' for the classification of ethnic groups in health research: the Dutch experience.

Karien Stronks, Isik Kulu-Glasgow, Charles Agyemang (2009)

The relationship between ethnicity and health is attracting increasing attention in international health research. Different measures are used to operationalise the concept of ethnicity. Presently, self-definition of ethnicity seems to gain favour. In contrast, in the Netherlands, the use of country of birth criteria have been widely accepted as a basis for the identification of ethnic groups. In this paper, we will discuss its advantages as well as its limitations and the solutions to these limitations from the Dutch perspective with a special focus on survey studies. The country of birth indicator has the advantage of being objective and stable, allowing for comparisons over time and between studies. Inclusion of parental country of birth provides an additional advantage for identifying the second-generation ethnic groups. The main criticisms of this indicator seem to refer to its validity. The basis for this criticism is, firstly, the argument that people who are born in the same country might have a different ethnic background. In the Dutch context, this limitation can be addressed by the employment of additional indicators such as geographical origin, language, and self-identified ethnic group. Secondly, the country of birth classification has been criticised for not covering all dimensions of ethnicity, such as culture and ethnic identity. We demonstrate in this paper how this criticism can be addressed by the use of additional indicators. In conclusion, in the Dutch context, country of birth can be considered a useful indicator for ethnicity if complemented with additional indicators to, first, compensate for the drawbacks in certain conditions, and second, shed light on the mechanisms underlying the association between ethnicity and health.

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Unravelling the impact of ethnicity on health in Europe: the HELIUS study

Karien Stronks, Marieke Snijder, Ron JG Peters … (2013)

Background Populations in Europe are becoming increasingly ethnically diverse, and health risks differ between ethnic groups. The aim of the HELIUS (HEalthy LIfe in an Urban Setting) study is to unravel the mechanisms underlying the impact of ethnicity on communicable and non-communicable diseases. Methods/design HELIUS is a large-scale prospective cohort study being carried out in Amsterdam, the Netherlands. The sample is made up of Amsterdam residents of Surinamese (with Afro-Caribbean Surinamese and South Asian-Surinamese as the main ethnic groups), Turkish, Moroccan, Ghanaian, and ethnic Dutch origin. HELIUS focuses on three disease categories: cardiovascular disease (including diabetes), mental health (depressive disorders and substance use disorders), and infectious diseases. The explanatory mechanisms being studied include genetic profile, culture, migration history, ethnic identity, socio-economic factors and discrimination. These might affect disease risks through specific risk factors including health-related behaviour and living and working conditions. Every five years, participants complete a standardized questionnaire and undergo a medical examination. Biological samples are obtained for diagnostic tests and storage. Participants’ data are linked to morbidity and mortality registries. The aim is to recruit a minimum of 5,000 respondents per ethnic group, to a total of 30,000 participants. Discussion This paper describes the rationale, conceptual framework, and design and methods of the HELIUS study. HELIUS will contribute to an understanding of inequalities in health between ethnic groups and the mechanisms that link ethnicity to health in Europe.

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Socioeconomic inequalities in cardiovascular disease mortality; an international study.

V Kunst, A. E. J. M. Cavelaars, F. Groenhof … (2000)

Differences between socioeconomic groups in mortality from and risk factors for cardiovascular diseases have been reported in many countries. We have made a comparative analysis of these inequalities in the United States and 11 western European countries. The aims of the analysis were (1) to compare the size of inequalities in cardiovascular disease mortality between countries, and (2) to explore the possible contribution of cardiovascular risk factors to the explanation of between-country differences in inequalities in cardiovascular disease mortality. Data on ischaemic heart disease, cerebrovascular disease and total cardiovascular disease mortality by occupational class and/or educational level were obtained from national longitudinal or unlinked cross-sectional studies. Data on smoking, alcohol consumption, overweight and infrequent consumption of fresh vegetables by occupational class and/or educational level were obtained from national health interview or multipurpose surveys and from the European Union's Eurobarometer survey. Age-adjusted rate ratios for mortality were correlated with age-adjusted odds ratios for the behavioural risk factors. In all countries mortality from cardiovascular diseases is higher among persons with lower occupational class or lower educational level. Within western Europe, a north-south gradient is apparent, with relative and absolute inequalities being larger in the north than in the south. For ischaemic heart disease, but not for cerebrovascular disease, an even more striking north-south gradient is seen, with some 'reverse' inequalities in southern Europe. The United States occupy intermediate positions on most indicators. Inequalities in cardiovascular disease mortality are associated with inequalities in some risk factors, especially cigarette smoking and excessive alcohol consumption. Socioeconomic inequalities in cardiovascular disease mortality are a major public health problem in most industrialized countries. Closing the gap between low and high socioeconomic groups offers great potential for reducing cardiovascular disease mortality. Developing effective methods of behavioural risk factor reduction in the lower socioeconomic groups should be a top priority in cardiovascular disease prevention. Copyright 2000 The European Society of Cardiology.

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Author and article information

Contributors

David N. Adjei:

ORCID: http://orcid.org/0000-0003-2306-5723

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Karien Stronks: Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: Writing – original draftRole: Writing – review & editing

Dwomoa Adu: Role: VisualizationRole: Writing – original draftRole: Writing – review & editing

Marieke B. Snijder: Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Project administrationRole: Writing – original draftRole: Writing – review & editing

Pietro A. Modesti: Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Ron J. G. Peters: Role: ConceptualizationRole: MethodologyRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Liffert Vogt: Role: ConceptualizationRole: InvestigationRole: MethodologyRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Charles Agyemang: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Jacobus P. van Wouwe: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 1 November 2017

Publication date Collection: 2017

Volume: 12

Issue: 11

Electronic Location Identifier: e0186460

Affiliations

[1 ] Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

[2 ] Department of Medical Laboratory Sciences, School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana

[3 ] Department of Medicine, School of Medicine and Dentistry, University of Ghana and Korle-Bu Teaching Hospital, Accra, Ghana

[4 ] Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy

[5 ] Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

[6 ] Department of Internal Medicine, section Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

TNO, NETHERLANDS

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: dna@ 123456chs.edu.gh , d.n.adjei@ 123456amc.uva.nl

Author information

David N. Adjei http://orcid.org/0000-0003-2306-5723

Article

Publisher ID: PONE-D-16-46485

DOI: 10.1371/journal.pone.0186460

PMC ID: 5665422

PubMed ID: 29091928

SO-VID: ea5dcdf3-6bb2-4cfb-b216-ab7b3b295c19

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 23 November 2016

Date accepted : 2 October 2017

Page count

Figures: 0, Tables: 3, Pages: 14

Funding

Funded by: Dutch Heart Foundation, the Netherlands Organization for Health Research and Development (ZonMw), and the European Union (Seventh Framework Program [FP7])

Award ID: FP7

Award Recipient : Karien Stronks

This work was supported by the Dutch Heart Foundation, the Netherlands Organization for Health Research and Development (ZonMw), and the European Union (Seventh Framework Program [FP7]). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Data Availability Data are available from the HELIUS research cohort, a third party. Dr. Snijder and Dr. Peters are affiliated with the HELIUS research cohort and are co-authors of this paper in accordance with the HELIUS requirements for collaboration. Dr. Snijder is the Data Collection Coordinator of HELIUS and may be contacted with further questions ( m.b.snijder@ 123456amc.uva.nl ). Additionally, researchers interested in further collaboration with HELIUS may see the following URL: http://www.heliusstudy.nl/nl/researchers/collaboration.

Relationship between educational and occupational levels, and Chronic Kidney Disease in a multi-ethnic sample- The HELIUS study

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Most cited references 36

The utility of 'country of birth' for the classification of ethnic groups in health research: the Dutch experience.

Unravelling the impact of ethnicity on health in Europe: the HELIUS study

Socioeconomic inequalities in cardiovascular disease mortality; an international study.

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