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Author Notes:

Corresponding author: Deidra C. Crews, MD, ScM, Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, 301 Mason F. Lord Drive, Suite 2500, Baltimore, Maryland 21224, Telephone: 410-550-2820, Facsimile: 410-550-7950, dcrews1@jhmi.edu

The authors thank the other investigators, the staff, and the participants of the REGARDS study for their valuable contributions. A full list of participating REGARDS investigators and institutions can be found at http://www.regardsstudy.org

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke or the National Institutes of Health.

Representatives of the funding agency have been involved in the review of the manuscript but not directly involved in the collection, management, analysis or interpretation of the data.

Financial Disclosure: The authors declare that they have no other relevant financial interests.


Research Funding:

This research project is supported by a cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Department of Health and Human Service.

Dr. Crews is supported by the Harold Amos Medical Faculty Development Program of the Robert Wood Johnson Foundation.

Dr. Powe is supported, in part, by grant K24DK02643 from the National Institute of Diabetes and Digestive and Kidney Diseases.


  • Race
  • Albuminuria
  • Poverty
  • Chronic kidney disease (CKD)
  • Socioeconomic status
  • Disparity

Low Income and Albuminuria Among REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study Participants


Journal Title:

American Journal of Kidney Diseases


Volume 60, Number 5


, Pages 779-786

Type of Work:

Article | Post-print: After Peer Review


Background: Albuminuria is an important risk factor for progressive CKD and is more prevalent among black than among white adults. We sought to determine the association between low income and albuminuria, and if this association differs for blacks and whites. Study Design: Cross-sectional study. Setting & Participants: 9,144 black and 13,684 white U.S. adults aged 45 years and older in the population-based REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Predictors: Self-reported annual household income category (≥$75,000, 35,000 – $74,999, $20,000 – $34,999, and <$20,000); black and white race. Outcomes & Measurements: Albuminuria defined as high (30 to 300 mg/g) or very high (>300 mg/g) urinary albumin-creatinine ratio (ACR). Multinomial logistic regression used to examine the race-stratified association between categories of income and albuminuria (normal, high, or very high ACR). Results: Overall, geometric mean ACR was 10.2 mg/g, and was higher for blacks (11.8 mg/g) than for whites (9.3 mg/g), p <0.001. Lower income was associated with a higher prevalence of albuminuria for both whites and blacks in unadjusted analyses. After adjustment for demographics, lifestyle factors, comorbid illnesses and estimated glomerular filtration rate, there was a trend towards a stronger association between lower income levels and high ACR among blacks [ORs of 1.38 (95% CI, 1.07 – 1.77), 1.36 (95% CI, 1.05 – 1.75), and 1.58 (95% CI, 1.21–2.05), for income levels of $35,000 – $74,999, $20,000 – $34,999, and <$20,000, respectively; reference group is those with income ≥$75,000] compared to whites [ORs of 0.95 (95% CI, 0.81 – 1.12), 0.95 (95% CI, 0.79 – 1.14), and 1.26 (95% CI, 1.02 – 1.55), respectively]; P interaction 0.08 between race and income. Results were similar for very high ACR, and subgroups of participants with diabetes or hypertension. Limitations: Cross-sectional design; not all REGARDS participants provided their annual income. Conclusions: Lower income may be more strongly associated with albuminuria among blacks than among whites, and may be a determinant of racial disparities in albuminuria.

Copyright information:

© 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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