Original Investigations: Pathogenesis and Treatment of Kidney Disease and Hypertension
The effect of renal insufficiency on workforce participation in the United States: An analysis using national health and nutrition examination survey III data*,**,*

https://doi.org/10.1053/ajkd.2002.36854Get rights and content

Abstract

Background: End-stage renal disease is associated with workforce nonparticipation, but no previous study has assessed the impact of renal insufficiency on employment status from a population standpoint. Methods: To determine whether renal insufficiency is independently associated with labor force participation, an analysis was performed using observational data from the Third National Health and Nutrition Examination Survey, which represents a cross-sectional sample of the US population. Five thousand five hundred fifty-eight subjects of the civilian noninstitutionalized US population aged 18 to 64 years provided complete information regarding key variables. A logistic regression equation with workforce participation as the dependent variable was created. Explanatory variables included age, sex, race, marital status, census region, and education, as well as the health-state indicators of general health status, presence or absence of diabetes, hypertension, stroke, congestive heart failure, myocardial infarction, and an indicator of renal function. Renal dysfunction was defined by serum creatinine values greater than 1.7 mg/dL (150 μmol/L) for women and greater than 2.0 mg/dL (180 μmol/L) for men. Results: Renal dysfunction was independently associated with labor force nonparticipation, with an odds ratio of 7.94 (95% confidence interval, 1.60 to 39.43). This relationship remained statistically significant after subjects with markedly elevated serum creatinine levels were excluded. Conclusion: A previously unrecognized independent association between renal function and labor force participation was identified. This group of patients warrants further attention regarding identification of specific factors leading to nonemployment, potential for workforce rehabilitation, and assessment of the impact of renal insufficiency in other functional spheres. Am J Kidney Dis 40:1132-1137. © 2002 by the National Kidney Foundation, Inc.

Section snippets

Methods

We estimated workforce participation and its dependence on renal function by studying individuals aged 18 to 64 years who participated in the NHANES III. The NHANES III was conducted by the National Centers for Health Statistics from 1988 to 1994. It provides nationally representative cross-sectional data on the overall health and nutritional status of the civilian noninstitutionalized US population.11, 12 Complex multistage sampling involving deliberate oversampling of ethnic groups, children,

Results

Characteristics of those of working age included in the analysis (n = 5,558) were similar to those who were excluded, except for the variables of sex (61% versus 46% women, respectively) and age group (40% versus 24% in the 18- to 29-year-old group, 21% versus 31% in the 30- to 39-year-old group, 15% versus 25% in the 40- to 49-year-old group, and 23% versus 20% in the 50- to 64-year-old group). Characteristics of the 5,558 sample participants with complete data for all variables of interest

Discussion

Analysis of NHANES III data shows that renal dysfunction is associated with a marked reduction in workforce participation among subjects aged 18 to 64 years. This association is independent of other demographic, socioeconomic, and health-related variables, including states that may influence both renal function and work status, such as diabetes mellitus and cardiovascular disease. Serum creatinine level greater than 2.0 mg/dL (180 μmol/L) or 1.7 mg/dL (150 μmol/L) for men and women was

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    *

    Supported in part by the Alberta Heritage Foundation for Medical Research.

    **

    Address reprint requests to Scott Klarenbach, MD, Institute of Health Economics, #1200, 10405 Jasper Ave, Edmonton, Alberta, Canada T5J 3N4. E-mail: [email protected]

    *

    0272-6386/02/4006-0002$35.00/0

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