In 2015–2016, age-adjusted prevalence of self-reported disability in U.S. adults aged 65+ years was greater in those with CKD stages 3 and 4 compared to those at stages 1 and 2; however, a higher percentage of elderly adults at CKD stages 1 and 2 self-reported disability in walking than compared to those at stages 3 and 4 (36% vs. 28%, repsectively).
Chart Explanation: Among U.S. adults aged 65+ years in 2015–2016, the age-adjusted prevalence of self-reported disability remained higher in persons with CKD stages 3 and 4 when compared to those with stages 1 and 2 or with no CKD. Specifically, those at stages 3 and 4 had a higher percentage of people self-report disability in hearing, concentrating and doing errands alone (24.4%, 12.5%, and 17.3%) compared to those at stages 1 and 2 (23.3%, 9.9%, and 14.6%, respectively). However, those at stages 1 and 2 had a higher percentage of elderly adults self-report disability in walking than compared to those at stages 3 and 4 or no CKD (36.1% vs. 28.1% vs. 20.1%, respectively). In those with CKD stages 3 and 4, the most frequently reported disability was walking (28.1%), and the least dressing and bathing (10.7%).
The National Health and Nutrition Examination Survey (NHANES) is a nationally representative, cross-sectional survey that is currently conducted every two years by the Centers for Disease Control and Prevention's National Center for Health Statistics to examine disease prevalence and trends over time in noninstitutionalized U.S. civilian residents.
Although much information is available regarding disability among those with end-stage renal disease (ESRD) (United States Renal Disease System, 2017), little has been reported regarding the burden of disability among those with earlier-stage CKD. The survey consists of a standardized in-home interview and a physical examination and blood and urine collection at a mobile examination center. Here we examined data from the 2013–2014 and 2015–2016 NHANES. The six items used to define self-reported disability are viewed as the minimum standards for disability status by the U.S. Department of Health and Human Services. Self-reported disabilities were defined by answers of “yes” to questions such as “Are you deaf or do you have serious difficulty hearing?”
|Description of Measure||Prevalence of disability among those with CKD in the general population|
|Type of Data Source||Public|
|Health Care System Data||No|
|Regional or National?||National|
|Demographic Group||Noninstitutionalized U.S. residents aged 65+ years|
|Numerator||Nonpregnant participants with completed disability surveys and with CKD information who reported having disabilities|
|Denominator||Nonpregnant participants with completed disability surveys and with CKD information|
|Definition of CKD||Presence of single albuminuria or estimated glomerular filtration rate (eGFR) 15-59 ml/min/1.73 m2|
|Glomerular filtration rate||Estimated using CKD-EPI equation for calibrated creatinine: eGFR=141 x [min(calibrated serum creatinine in mg/dL) /κ, 1)]α x [max(calibrated serum creatinine in mg/dL/κ, 1)]κ x 0.993age x (1.018 if female) x (1.159 if non-Hispanic Black)|
κ = 0.7 if female, and 0.9 if male
α = -0.329 if female, and -0.411 if male
|Proteinuria||Urinary albumin-to-creatinine ratios of 30-299 mg/g (microalbuminuria) and ≥300 mg/g (macroalbuminuria); pregnant/menstruating women excluded|
|Primary Data Source Indicator||dlqXXX variables|
|Primary Indicator Method of Measurement||Questionnaire (computer-assisted); disability survey given to participants ages 1+ (proxy provided for ages 1-15); indiciator sample covers ages 65+|
|Secondary (1) Variable||lbxscr: Serum creatinine measurements taken for ages 12+; indicator covers measurements for ages 65+|
|Secondary (1) Indicator Method of Measurement||Examination/Laboratory|
|Secondary (2) Variable||ridageyr: Age in years|
|Secondary (2) Indicator Method of Measurement||Questionnaire (interviewer-administered)|
|Frequency of Measurement (Primary)||Once (cross-sectional)|
|U.S. Region Covered by Primary Variable||All|
|Period Currently Available||2013–2016|
|Additional Data Items of Interest||Stage of CKD, other stratification variables of interest (disability by gender, disability by race/ethnicity)|
|Limitations of Indicator||Self-reported, cross-sectional, missing data due to refusal; albuminuria single measurement|
|Analytic Considerations||Appropriate NHANES survey weights, including mobile examination center weights, must be used for all analyses; creatinine measurements must be calibrated for NHANES III, 1999-2000 and 2005-2006; many variable names differ across surveys; albuminuria must be adjusted over multiple years|
|Age Adjustment||Adjusted for the distribution of age within the sample|
References and Sources:
U.S. Department of Health and Human Services. U.S. Department of Health and Human Services Implementation Guidance on Data Collection Standards for Race, Ethnicity, Sex, Primary Language, and Disability status. 2011.