Abstract
Energy burden, the inability to afford sufficient energy sources for basic household needs such as heating, cooling, cooking, and lighting, is one of the major social challenges in the U.S. While limited studies have examined these issues separately, to our knowledge, no study has empirically investigated the implication of energy burden for chronic kidney disease (CKD) within the U.S. context. This study aims to examine the association between energy burden and CKD prevalence across 500 U.S. cities by using nationally representative data sets. Utilizing propensity score matching and a random intercept analysis, we found that census tracts with high energy burden were significantly associated with a 0.195 higher chronic kidney prevalence [95% CI: 0.144-0.246] compared to those with low energy burden, after adjusting key observed characteristics such as living, housing, and sociodemographic conditions of census tracts. Other risk factors contributing to increased CKD prevalence included older building age, higher percentages of nonwhite populations and older adults, lower educational levels, and lower average household incomes. The findings highlight that energy burden is not merely a financial problem but rather a social determinant of CKD health and a significant risk factor for increased CKD prevalence in U.S. urban areas. Our results indicate that state and local energy assistance programs may serve as important interventions not only for improving kidney health outcomes but also for reducing health disparities in the U.S.