Background
To investigate the impact of area socioeconomic deprivation on the risk of major adverse kidney events (MAKEs) within 90 days post-discharge among patients with acute kidney injury (AKI).
Methods
This retrospective cohort study included patients with AKI between January 1, 2014, and December 31, 2023. Area socioeconomic deprivation index was calculated using principal component analysis based on district-level economic and healthcare resource data from patients‘ registered residential areas. Patients were stratified into four deprivation quartiles (Q1-Q4) and analyzed with multivariable Cox proportional hazards regression models to assess the association between deprivation index and MAKE risk.
Results
Among 5,934 AKI patients, 1,107 (18.7%) experienced MAKEs within 90-day follow-up. Multivariable Cox regression analysis revealed that patients in the highest deprivation quartile (Q4) had a significantly greater risk of MAKEs than those in the lowest deprivation quartile (Q1) (hazard ratio [HR] 1.48, 95% CI: 1.24-1.77), with a significant dose-response relationship between MAKE risk and (trend p < 0.001). Subgroup analysis revealed that the negative effect of area socioeconomic deprivation was more pronounced among patients with lower levels of health insurance coverage (resident medical insurance/Self-pay) (interaction p = 0.032). Mediation analysis indicated that the delay between discharge and the first outpatient follow-up mediated approximately 23.2% of the area socioeconomic deprivation effect.
Conclusion
Area socioeconomic deprivation is a key socioenvironmental determinant of outcome in AKI patients. This finding suggests a significant association of macrolevel social environments on disease outcomes. Therefore, social environment assessments should be integrated into AKI clinical management systems for systematically reducing health inequalities.