Epidemiology of chronic kidney disease in Peru and its relation to social determinants of health.

ABSTRACT

BACKGROUND: Chronic kidney disease (CKD) is a growing public health problem and an important cause of morbidity and mortality. Disparities in CKD may be related to social determinants and health inequalities in low- and middle-income countries. This study determined how social determinants of health influence trends in the prevalence and mortality of CKD in Peru. METHODS: This was an ecological study based on a secondary analysis of health care and death records obtained from the Ministry of Health of Peru for the period 2010-2016. The standardized prevalence and mortality rates of CKD were descriptively reported using geospatial exploratory analysis. We also determined the association with social determinants of health according to the domains suggested by Healthy People 2020. RESULTS: In the studied period, CKD prevalence increased by 300% and was associated with the health insurance coverage rate (ß=5.9 [95% CI 0.82 to 10.92]), proportion of people with a secondary education level (ß=11.4 [95% CI 1.94 to 20.93]), mean age (ß=-10.7 [95% CI -19.33 to -2.12]), monetary poverty rate (ß=-2.2 [95% CI -3.88 to -0.60]) and gross domestic product per capita (ß=-63.2 [95% CI -117.81 to -8.52]). The standardized mortality decreased by 10% and was associated with mean age (ß=-0.6 [95% CI -1.22 to -0.06]) and the proportion of people with a primary education level (ß=-0.5 [95% CI -0.9 to -0.05]). CONCLUSIONS: During the period 2010-2016, the prevalence of CKD increased and the mortality associated with CKD decreased. The observed changes were associated with some social determinants of health, such as increased health coverage and education. The health system of Peru must be prepared to take on the challenge.