Structural determinants of survival in hemodialysis: body mass index as a marker of social vulnerability in a Brazilian cohor
1
Graduate Program in Public Health, Federal University of Espirito Santo, Vitoria, Brazil
2
Departament of Nutrition, Federal University of Espirito Santo, Vitoria, Brazil
3
Graduate Program in Nutrition and Health, Federal University of Espirito Santo, Vitoria, Brazil
4
Departament of Nutrition, Federal University of Maranhão, São Luís, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A2860
ABSTRACT
INTRODUCTION:
The survival of individuals undergoing hemodialysis is not determined solely by clinical characteristics (1). in healthcare systems marked by socioeconomic inequalities, nutritional status reflects cumulative social vulnerability, including restricted access to healthy foods, fragmented care, and unequal health literacy (2). This study analyzes how survival patterns in hemodialysis are shaped by the interaction between body mass index (bmi) and social determinants, with BMI as a structural indicator rather than an individual risk marker.
METHODS:
We conducted a retrospective cohort study of 953 adults with chronic kidney disease on hemodialysis in espírito santo, brazil, with baseline sociodemographic, clinical and nutritional data collected in 2019 and mortality follow-up through 2022. Survival probabilities were estimated using kaplan–meier curves stratified by bmi and age groups. group differences were evaluated using the log-rank test. cox proportional hazards models were applied to assess all-cause and cardiovascular mortality, adjusting for age, sex, time since diagnosis, smoking, and education.
RESULTS:
During 36 months of follow-up, 326 deaths occurred; cardiovascular diseases were the leading cause (32.8%). individuals classified as eutrophic showed the highest survival across adult and older-adult strata, while those with overweight exhibited consistently lower survival probabilities (log-rank p < 0.05). in the adjusted cox model for cardiovascular mortality, never having smoked was protective (hr 0.62; 95% ci 0.41–0.96), as was ≥11 years of schooling (hr 0.35; 95% ci 0.13–0.89). BMI categories did not retain independent significance after adjustment, indicating mediation by social conditions.
CONCLUSIONS:
Survival rates on hemodialysis are influenced by social patterns, and nutritional status, measured by body mass index, serves as an indicator of structural inequality rather than biological risk alone. Policies focused exclusively on individual behavioral or nutritional counseling are insufficient. Integrated public policies addressing education, food access, continuity of care, and socioeconomic vulnerability are necessary to ensure equitable survival rates.
The survival of individuals undergoing hemodialysis is not determined solely by clinical characteristics (1). in healthcare systems marked by socioeconomic inequalities, nutritional status reflects cumulative social vulnerability, including restricted access to healthy foods, fragmented care, and unequal health literacy (2). This study analyzes how survival patterns in hemodialysis are shaped by the interaction between body mass index (bmi) and social determinants, with BMI as a structural indicator rather than an individual risk marker.
METHODS:
We conducted a retrospective cohort study of 953 adults with chronic kidney disease on hemodialysis in espírito santo, brazil, with baseline sociodemographic, clinical and nutritional data collected in 2019 and mortality follow-up through 2022. Survival probabilities were estimated using kaplan–meier curves stratified by bmi and age groups. group differences were evaluated using the log-rank test. cox proportional hazards models were applied to assess all-cause and cardiovascular mortality, adjusting for age, sex, time since diagnosis, smoking, and education.
RESULTS:
During 36 months of follow-up, 326 deaths occurred; cardiovascular diseases were the leading cause (32.8%). individuals classified as eutrophic showed the highest survival across adult and older-adult strata, while those with overweight exhibited consistently lower survival probabilities (log-rank p < 0.05). in the adjusted cox model for cardiovascular mortality, never having smoked was protective (hr 0.62; 95% ci 0.41–0.96), as was ≥11 years of schooling (hr 0.35; 95% ci 0.13–0.89). BMI categories did not retain independent significance after adjustment, indicating mediation by social conditions.
CONCLUSIONS:
Survival rates on hemodialysis are influenced by social patterns, and nutritional status, measured by body mass index, serves as an indicator of structural inequality rather than biological risk alone. Policies focused exclusively on individual behavioral or nutritional counseling are insufficient. Integrated public policies addressing education, food access, continuity of care, and socioeconomic vulnerability are necessary to ensure equitable survival rates.
| eISSN: | 2654-1459 |
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