Clinical Pediatrics

Socioeconomic status (SES) factors such as employment, educational attainment, income, and marital status can affect the health and well-being of the general population and have been associated with the prevalence of chronic kidney disease (CKD). However, no studies to date in Japan have reported on the prognosis of patients with CKD with respect to SES. This study aimed to investigate the influences of employment and education level on mortality and hospitalization among maintenance hemodialysis (HD) patients in Japan. Data on 7974 HD patients enrolled in DOPPS phases 1–4 (1999–2011) in Japan were analyzed. Cox regression modeled the association between employment and both mortality and hospitalization among patients <60 years old. The association between education and outcomes was also assessed. The association between patient characteristics and employment among patients <60 years old was assessed using logistic regression. During a median follow-up of 24.9 months, 10% of patients died and 43% of patients had an inpatient hospitalization. Unemployment was associated with mortality and hospitalization. Compared to patients who graduated from university, patients with less than a high school (HS) education and patients who graduated HS with some college tend to have elevated mortality but were not at  risk for increased hospitalizations. Employment and education status were inversely associated with mortality in patients on maintenance HD in Japan. Employment but not education was also inversely associated with hospitalizations. After adjustment for comorbidities, the associations with clinical outcomes tended to be stronger for employment than education status.