Association of home- and community-based services with incident chronic kidney disease among patients with diabetes: a longitudinal study of CHARLS
Year: 2026
Type: article
Study design: Observational Study
Abstract: Home- and community-based services (HCBS) serve as a non-institutional care and support model, exhibiting application potential in chronic disease management. However, longitudinal evidence supporting the association between HCBS and the risk of incident chronic kidney disease (CKD) in patients with diabetes remains scarce. To investigate the potential association between HCBS and incident CKD risk in diabetic patients. Based on 2015–2020 data from the China Health and Retirement Longitudinal Study (CHARLS), this longitudinal cohort study included individuals with prevalent diabetes in 2015 and no CKD before 2018. Participants were grouped by HCBS utilization in 2018. Weighted logistic regression models were used to examine the association between HCBS and the risk of incident CKD among patients with diabetes. Subgroup analyses were performed stratified by age, sex, residence, education level, marital status, smoking, alcohol consumption, hypertension and dyslipidemia. Sensitivity analysis, E-value calculation and weighted Poisson regression with robust standard errors were conducted to verify the robustness of the results. A total of 1,269 diabetic patients were enrolled, among whom 283 (22.3%) received HCBS. During follow-up, the incidence of incident CKD was 3.9% in the HCBS group, which was lower than 6.4% in the non-HCBS group (P = 0.018). After full adjustment for confounders, HCBS utilization was associated with a reduced risk of incident CKD (OR = 0.39, 95%CI: 0.18–0.85, P = 0.018). Interaction tests revealed no significant interactions across all subgroups (P-interaction > 0.05). Several stratified analyses yielded statistically significant results, yet no obvious effect modification was observed. Sensitivity analyses further confirmed the robustness of our findings. Among diabetic participants in the CHARLS cohort, HCBS utilization was associated with a lower risk of incident CKD during follow-up. This finding provides empirical evidence from middle-aged and older Chinese adults for integrating community-based health management, care services and social support into strategies for preventing and managing diabetic complications. Not applicable. Based on the nationwide longitudinal cohort of the China Health and Retirement Longitudinal Study (CHARLS) from 2015 to 2020, this study aimed to evaluate the association between home- and community-based elderly care services (HCBS) and the risk of incident chronic kidney disease (CKD) among patients with diabetes. Subgroup analyses showed consistent directional associations across multiple populations, while no statistically significant interactions were observed. Sensitivity analyses, E-value assessment and weighted Poisson regression with robust standard errors further verified the robustness of the primary findings.
Source: BMC Nephrology
Authors: Xiaomeng Xu, Manman Huang, Xueya Wen
Institution: Chinese People's Liberation Army
Language: English
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,090
OpenAlex ID: W7204883130
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