Socioeconomic status and mortality among dialysis patients: a systematic review and meta-analysis

  • Sibei Tao
  • Xiaoxi Zeng
  • Jing Liu
  • Ping FuEmail author
Nephrology - Original Paper



The reported association between individual indicators of socioeconomic status (SES) and mortality in dialysis patients was inconsistent in previous studies. We performed a meta-analysis to identify the association between SES and mortality of dialysis population.


The meta-analysis was conducted in accordance with MOOSE guidelines. Cohorts evaluating the association between SES indicators (income, education and occupation) and mortality in dialysis patients were included. Random-effects models were used to pool the adjusted relative risk (RR) from individual studies. Heterogeneity was assessed by Cochrane’s Q and the I2 statistic. Subgroup analyses and sensitivity analyses were performed to identify sources of heterogeneity and to evaluate the robustness of findings.


Fourteen studies were finally included. In hemodialysis patients, increased mortality was associated with lower level of income (RR = 1.08, 95%CI [1.01–1.16], P = 0.035; I2 = 87.9%, P < 0.001) and occupation (RR = 1.63, 95%CI [1.11–2.38], P = 0.013; I2 = 0.0%, P = 0.601). However, no significant association was identified for education (RR = 1.43, 95%CI [0.92–2.25]; P = 0.112; I2 = 68.3%,P = 0.001). In patients receiving peritoneal dialysis, lower level of income (RR = 1.80, 95%CI [1.12–2.88],P = 0.015; I2 = 75.9%, P = 0.042), education (RR = 1.27, 95%CI [1.13–1.43], P < 0.001; I2 = 0.0%, P = 0.684), and occupation (RR = 3.42, 95% CI [1.35–8.70], P = 0.010) were risk factors for increased mortality. Subgroup analysis showed the association between SES indicators and mortality in hemodialysis differed according to geographic locations and study designs.


Lower SES (measured by income, education, and occupation) tends to be associated with higher mortality in patients receiving maintenance dialysis. But the magnitude of the associations varied for different individual indicators of SES.


Socioeconomic status End-stage renal disease Dialysis Mortality Meta-analysis 



This work was supported by the International Cooperation Project (2016HH0069) funded by Science and Technology Department of Sichuan Province, China.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interest.

Supplementary material

11255_2019_2078_MOESM1_ESM.docx (19 kb)
Additional file 1: MOOSE Checklist. (DOCX 19 KB)
11255_2019_2078_MOESM2_ESM.docx (17 kb)
Additional file 2: Search Strategy. (DOCX 17 KB)
11255_2019_2078_MOESM3_ESM.doc (46 kb)
Additional file 3: Newcastle-Ottawa Quality Assessment Scale—Cohort Studies. (DOC 45 KB)
11255_2019_2078_MOESM4_ESM.tif (8.1 mb)
Additional file 4: Funnel plots. (TIF 8298 KB)


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Kidney Research Lab, Division of Nephrology, West China School of MedicineWest China Hospital of Sichuan UniversityChengduChina
  2. 2.West China Biomedical Big Data CenterSichuan UniversityChengduChina

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