The relationship between financial hardship and incident diabetic kidney disease in older US adults – a longitudinal study

Abstract

Background Financial hardship is associated with poor health, however the association of financial hardship and incident diabetic kidney disease (DKD) is unknown. This study aimed to examine the longitudinal relationship between financial hardship and incident DKD among older adults with diabetes. Methods Analyses were conducted in 2735 adults age 50 or older with diabetes and no DKD using four waves of data (2006–2012) from the Health and Retirement Study, a national longitudinal cohort. The primary outcome was incident DKD. Financial hardship was based on three measures: 1) difficulty paying bills; 2) food insecurity; and 3) cost-related medication non-adherence using validated surveys. A dichotomous financial hardship variable (0 vs 1 or more) was constructed based on all three measures. Cox regression models were used to estimate the association between financial hardship, change in financial hardship experience and incident DKD adjusting for demographics, socioeconomic status, and comorbidities. Results During the median follow-up period of 4.1 years, incident DKD rate was higher in individuals with versus without financial hardship (41.2 versus 27/1000 person years). After adjustment, individuals with financial hardship (HR 1.32, 95% CI 1.04–1.68) had significantly increased likelihood of developing DKD compared to individuals without financial hardship. Persistent financial hardship (adjusted HR 1.52 95% CI 1.06–2.18) and negative financial hardship (adjusted HR 1.54 95% CI 1.02–2.33) were associated with incident DKD compared with no financial hardship experience. However, positive financial hardship was not statistically significant in unadjusted and adjusted (adjusted HR 0.89 95% CI 0.55–1.46) models. Cost-related medication non-adherence (adjusted HR 1.43 95% CI 1.07–1.93) was associated with incident DKD independent of other financial hardship measures. Conclusions Financial hardship experience is associated with a higher likelihood of incident DKD in older adults with diabetes. Future studies investigating factors that explain the relationship between financial hardship and incident DKD are needed.

Association of Food Insecurity With Allostatic Load Among Older Adults in the US

“…In addition, there was suggestive evidence that SNAP participation may mitigate the association of AL with moderate and severe food insecurity. Overall, these findings suggest that the link between food insecurity and an increased risk of chronic disease could be mediated by physiologic dysregulation and that appropriate intervention could help modify this association …”

“…Overall, these findings suggest that the link between food insecurity and an increased risk of chronic disease 3,4,6,[11][12][13][14][15] could be mediated by physiologic dysregulation 26 and that appropriate intervention could help modify this association. 26,42,45,46 A higher level of C-reactive protein, a validated biomarker of inflammation, in food-insecure individuals corroborates the evidence that food insecurity is associated with inflammation and related immune responses.…”

“…An emerging body of literature has documented associations between food insecurity and chronic disease in individuals at older ages, including diabetes, heart disease, hypertension, kidney disease, obesity, and pulmonary disease. 3 , 4 , 6 , 10 , 11 , 12 , 13 , 14 , 15 Studies have reported that food-insecure older adults in the US and Canada were subject to higher mortality risk and shorter life spans than their food-secure peers. 16 , 17 , 18 , 19 , 20 Despite considerable evidence of its health consequences, little is known about the mechanisms by which food insecurity causes adverse health outcomes.…”

“…An emerging body of literature has documented associations between food insecurity and chronic disease in individuals at older ages, including diabetes, heart disease, hypertension, kidney disease, obesity, and pulmonary disease . Studies have reported that food-insecure older adults in the US and Canada were subject to higher mortality risk and shorter life spans than their food-secure peers .…”

Financial Hardship and Age-Related Decrements in Kidney Function Among Black and White Adults in the Midlife in the United States Study

“…In analysis using data from the Health and Retirement Study, Black adults reported significantly more financial hardship than White adults (26). In a different analysis involving US adults with diabetes, NH Black adults showed a higher likelihood of financial hardship (27). Black adults were also more likely to experience financial hardship due to major life events, such as a global pandemic (28) and cancer treatment diagnosis (29).…”