Dimensions of Social Capital Associated with the Presence and Risk of Chronic Kidney Disease in Adolescents

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Obrador-Vera, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8311858/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background Social capital (SC) is a recognized social determinant of health, and its influence chronic kidney disease (CKD) among adolescents remains poorly explored. Understanding this association may help identify modifiable social factors that shape early kidney health. Methods A case-control study involving 96 adolescents with CKD (aged 12 to 17 years) and 288 adolescents without CKD (controls: school children, family members, and community members). Data was collected using instruments to assess SC, social deprivation, and CKD risk factors. Associations between SC dimensions and CKD presence were analyzed using binary logistic regression (adjusted odds ratios, ORa), while CKD risk levels were examined with ordinal logistic regression (proportional odds ratio, ORp). The preventable fraction was estimated to evaluate the potential impact of protective SC dimensions. Results The study sample was 55.5% female, with a mean age of 14.9 years. Eleven of fifteen SC dimensions showed a significant protective association with CKD presence (ORa 0.58–0.85), and four dimensions were associated with reduced CKD risk (ORp 0.59–0.86). The preventable fraction for these protective dimensions ranged from 0.14 to 0.43, indicating a probable potential for prevention through social interventions. Conclusions Higher levels of social capital were consistently associated with lower CKD risk among adolescents. These findings suggest that strengthening the SC dimensions could serve as innovative public health strategies to reduce CKD prevalence and promote adolescent health. social capital chronic kidney disease adolescents social determinants of health preventable fraction Introduction Social capital (SC) has been studied in relation to various health issues ( 1 , 2 ). Accordingly, a concept of SC geared toward public health and community development has been established and defined as “the characteristics of social organization, such as networks, norms and social trust, that facilitate coordination and cooperation for mutual benefit” ( 3 ). The accumulation of SC reconciles individual and collective interests and has been consistently linked to improved health, social and economic outcomes ( 3 ). Mechanisms through wich SC influences health include: 1) collective socialization, promoting healthy behaviors and information sharing; 2) informal social control, establishing behavioral norms that maintain social order; 3) collective efficacy, enabling access to resources; and 4) social support, that provides emotional support ( 4 ). SC is measured through structural (SD) and cognitive (CD) domains. SD refers to observable processes and organization, whereas CD captures subjective perceptions of social relations. Both domains assess elements such as cooperation, collective action security an interpersonal trust. ( 5 ). Chronic kidney disease (CKD) has been extensively investigated from clinical perspectives, yet social determinants are equally important, since living and working conditions strongly shape health outcomes. Incorporating this broader view facilitates understanding of the interaction that arise once CKD is diagnosed ( 6 , 7 ). CKD represents a major global health burden, affecting more than 850 million people, with projections of 14.5 million reaching end-stage CKD by 2030 ( 8 , 9 ). In Aguascalientes (Mexico), prevalence rose from 2,075 cases per million population (pmp) in 2020 to 2,328 pmp in 2022, ranking seventh worldwide ( 10 ). The distribution is bimodal peaking at ages 20–40 and 50–70 years. Remarkably, in the younger group, Aguascalientes records the highest worldwide prevalence, with the cause classified as “unknown” in 73% of cases ( 11 ). Screening studies in adolescents revealed an incidence of CKD (Stage I G1A2) of 3.7% (95% confidence Interval -CI 2.1–5.3) ( 12 ). Studies in adults have associated SC to CKD related outcomes such as medication adherence ( 13 ), transplantation networks ( 14 ), and civic participation ( 15 ). Lack of neighborhood ties has been associated with limited support ( 16 ), while reciprocity within communities reduces the risk of chronic diseases such as diabetes or hypertension ( 17 ). In adolescents, SC has been studied in relation to different health problems, including oral health ( 18 ), mental health ( 19 – 21 ) and health perception ( 22 ). Evidence shows that self-rated good health, neighborhood trust, and reciprocity at school ( 23 ) were associated with higher SC, and increases in SC were associated with a reduced likelihood of smoking or using opioids ( 24 ). Hence, these studies indicate that SC is an important resource that helps adolescents improve, cope with and even prevent these problems. While there are studies evaluating the influence of SC on different health problems in the adolescent population, none of them has focused on CKD. The importance of SC in adolescents is that as an intermediate social determinant, it serves to mitigate social inequalities in health by influencing social configurations, and it can drive differences in exposure and vulnerability to conditions that compromise health ( 25 ). Based on the above, this study aimed to evaluate the strength of the association and the potential impact of the dimensions of SC on individual and on community health, specifically in relation to the presence and risk of CKD in Mexican adolescents. Materials and Methods An observational, case-control study was carried out, with a ratio of one case to three controls (school, family, or community members). Cases were adolescents aged 12 to 17 years with incident CKD, defined as albuminuria (albumin ≥ 30 mg/g creatinine) and/or a glomerular filtration rate ≤ 60 ml/min/1.73 m2 in two separate measurements taken at least 3 months apart, and with a percutaneous renal biopsy (KDIGO guidelines). The controls were adolescents aged 12 to 17 years, with no albuminuria (albumin ≤ 30 mg/g creatinine) or a glomerular filtration rate ≥ 60 mL/min/1.73 m². The study population included adolescents attending public or private secondary schools in three municipalities of Aguascalientes: Rincón de Romos, Calvillo and Aguascalientes. Prior to participation, informed consent was obtained from parents and assent from the adolescents. Those without consent, unwilling to participate or no longer residing in the municipalities were excluded. The Aguascalientes Institute of Education provided enrollment list from 130 secondary schools. From these 47 schools were randomly selected, representing a total of 17,355 students in their third year of secondary education. A random sample of 3,000 adolescents was drawn to identify potential cases and controls. Screening was performed to detect cases meeting CKD diagnostic criteria. Controls were chosen in three ways: 1) a classmate from the same school year, 2) a family member within two years of age and any degree of consanguinity, and 3) a community peer residing within a 9 block radios of the cases home, identified through systematic house selection. A specific questionnaire was developed to assess the validity and reliability of social capital related to CKD in Mexican adolescents, showing an adequate content and apparent validity. Construct validity indicated a construct validity of 72.78% of the explained variance for the CD, and 83.20 for the SD. Confirmatory analysis returned a chi-squared value of 142.99 (p = 0.05), a CFI of 0.97, a TLI of 0.96, a RMSEA of 0.040 and a SRMR of 0.07 for the CD. Similarly, a chi-squared of 408.296 (p < 0.001), a CFI of 0.98, a TLI of 0.97, a RMSEA 0.03 and a SRMR of 0.06 were returned for the SD. Criterium validity showed a mild to strongly significant correlation (p ≤ 0.001) among items and dimensions within each domain. Cronbach’s alpha was 0.84 and 0.94 for the CD and SD, respectively ( 26 ). All the interviews were conducted out face-to-face by trained interviewers using a standardized questionnaire of eight sections: personal details, sociodemographic characteristics, medical care, patient measurements, laboratory results, degree of wealth/poverty, CKD risk factors, and the SC instrument. The instrument for assessing SC and CKD among Mexican adolescents was previously standardized and published ( 26 ). Prior to participation, informed consent was obtained from parents or legal guardians, and adolescents provided written assent after receiving age-appropriate information. All participants were informed about the study objectives, the voluntary nature of participation, confidentiality, and their right to withdraw at any time. For the statistical analysis, the study population was first described to evaluate the distribution of variables across cases and controls. Central tendency measures (mean and standard deviation, or median and interquartile range) were used as appropriate. Dichotomous and ordinal variables were described using absolute frequencies and percentages. Group comparisons were performed using Pearson’s chi-square test and Student’s t-test. To assess associations, binary logistic regression was used to estimate adjusted odds ratios (ORs) between the presence of CKD and SC dimensions. The variables included in the models met the criteria for confounding variables. Model selection was guided by the Akaike Information Criterion (AIC), goodness-of-fit was tested with the Hosmer-Lemeshow test ( 27 ). To assess the association between CKD risk and SC dimensions, proportional Ors were estimated using ordinal logistic regression. Proportionality was tested with the likelihood ratio and Brand tests (p ≥ 0.05) ( 28 ). The potential impact of SC was expressed through ORa (1 – ORa), thereby obtaining the preventable fraction ( 29 , 30 ). Results A total of 96 cases and 288 controls were included in the study. There were no significant differences between the cases and the school, family, and community controls, indicating that these groups were homogeneous. The average age of the participants was 14.9 years, and there were no significant differences in gender distribution in all four groups. (Table 1 ). Table 1 Sociodemographic and clinical characteristics of the adolescents studied Cases n = 96 Controls School n = 96 Family n = 96 Community n = 96 n (%) n (%) n (%) n (%) Sex Male 43 (44.79) 47 (48.96) 44 (45.83) 49 (51.04) Female 53 (55.21) 49 (51.04) 52 (54.17) 47 (48.96) Age (߂ ± DS) 14.53 ± 0.89 14.21 ± 0.41 14.88 ± 2.04 14.26 ± 0.44 Level of Poverty☼ Not poor nor vulnerable 39 (40.62) 17 (17.71)** 13 (13.54)** 17 (17.71)** Multidimensional poverty 13 (13.54) 13 (13.54) 14 (14.58) 25 (26.04) Vulnerable due to shortages 43 (44.79) 59 (61.46) 66 (68.75) 49 (51.04) Vulnerable due to income 1 (1.04) 7 (7.29) 3 (3.12) 5 (5.21) Albuminuria (median ± IQR) 65.4(41.9–163) 7.55 (5.3–12.4)** 8.6 (5.9–11.7)** 8 (5.2–13.85)** Size (median ± IQR) 162 (158–168) 164 (157–167) 162 (158–168) 162 (158–167) P. Size (median ± IQR) 42 (25–66) 33.5 (21–64.5) 36 (18–62.5) 32 (16.5–53.5)* Weight (median ± IQR) 51.85 (45.35–62.35) 58.02 (51–63.72)** 56.95 (50.52–66.85)** 56.76 (50.05–67.85)** P. weight (median ± IQR) 46 (20.5–80.5) 69 (36–83.5) 69 (39–87.5)* 67 (32–89) Waist (median ± IQR) 73 (66-77.4) 73.75 (69–79.5)* 76 (68.5–81)* 74 (67.5–83) P. Waist (median ± IQR) 71.5 (34.5–77) 77 (41.5–88) 77 (38–91)* 74.5 (38–92) BMI (median ± IQR) 19.6 (17.4–22.6) 22.5 (19.55–24.25)** 21.75 (19.05–24.85)** 21.75 (19.55–26)** P. BMI (median ± IQR) 52 (19–81) 78 (44.5–88.5)** 78 (37.5–89)* 47.5 (71–94)** BMI Normal weight 78 (81.25) 66 (68.75)** 64 (66.77)* 63 (65.62)* Overweight 5 (5.21) 21 (21.88) 13 (13.54) 9 (9.38) Obese 13 (13.54) 9 (9.38) 9 (19.79) 24 ( 25 ) SAP (median ± IQR) 110 (100–117) 110 (100–116) 110 (100–120)* 110 (106.5–120) DAP (median ± IQR) 70 (60–74.5) 70 (64–77) 70 (70–80) 71 (70–80) *p ≤ 0.05, ** p ≤ 0.01, Pearson’s chi squared, Student t for independent samples, Mann-Whitney U test. Abbreviations: P, Percentage, BMI, Body Mass Index; SAP, Systolic arterial pressure; DAP, Diastolic arterial pressure. ☼ National Council for the Evaluation of Social Development Policy (CONEVAL) methodological evaluation. Poverty levels indicated social vulnerability, with significant differences among groups (cases: 44.8%; school: 61.4%; family: 68.7%; community: 51.04%; p ≤ 0.05). Median albuminuria was higher in cases (65.4mg/g; IQR 41.9–163) than in controls (7.6-8mg/g; p ≤ 0.01). Normal body mass index (BMI) was more frequent in cases, whereas controls was lower BMI (p ≤ 0.05). Systolic blood pressure was significantly higher in family controls (mean 110mmHg; IQR 100–120; p ≤ 0.05; Table 1 ). CKD was associated with three of the six dimensions of the CD of SC, ranging from an ORa of 0.57 to a maximum ORa of 0.86, the latter found between the cases and the school controls. The ORa of 0.86 associated with the generalized norms (reciprocity) dimension (95% CI 0.78–0.96; p ≤ 0.01) meaning that adolescents with greater reciprocity have a 14% lower risk of having CKD for each unit of the index relative to adolescents with a lower reciprocity (Table 2 ). By contrast, 8 of the 9 dimensions of the SD proved to be protective factors, with an ORa ranging from 0.63 to 0.85. Among the school cases and controls, adolescents with greater social contact with other peers and/or neighbors (network size) had a 30% lower risk of having CKD for each unit of the index relative to adolescents with less social contact with other peers and/or neighbors (Table 2 ). Table 2 Adjusted strength of the associations in the continuous dimension of social capital of health with the presence of chronic kidney disease in adolescents Dimension Index Cases n = 96 and School Controls n = 96 Multivariate model☼ Cases n = 96 and Family Controls n = 96 Conditional Model m¥ Cases n = 96 and Community Controls n = 96 Multivariate model Ø ORa 95% CI ORa 95% CI ORa 95% CI Cognitive Domain Social harmony (continuous scale) 1 1.11 1.003–1.24* Generalized norms (continuous scale) 2 0.86 0.78–0.96** 0.85 0.75–0.96** 0.82 0.75–0.90** Sense of belonging (continuous scale) 3 0.85 0.73–0.99* Confidence (continuous scale) 4 0.67 0.51–0.88** 0.61 0.46–0.83** 0.57 0.44–0.74** Structural Domain Participation in organizations (continuous scale) 1 0.70 0.56–0.88** 0.81 0.69–0.95* Membership of institutions (continuous scale) 2 0.81 0.73–0.89** 0.85 0.77–0.95** 0.74 0.67–0.83** Frequency of the activities (continuous scale) 3 0.71 0.63–0.81** 0.73 0.63–0.86** 0.70 0.62–0.80** Size of the networks (continuous scale) 4 0.70 0.61–0.80** 0.63 0.49–0.81** 0.66 0.58–0.76** Collective actions (continuous scale) 5 0.68 0.59–0.77** 0.75 0.65–0.86** 0.66 0.58–0.75** Degree of civic responsibility (continuous scale) 6 0.65 0.56–0.75** 0.57 0.43–0.76** 0.60 0.51–0.70** Diversity (continuous scale) 7 0.67 0.57–0.80** 0.77 0.63–0.95** 0.65 0.54–0.77** Belonging to groups with resources (continuous scale) 8 0.73 0.63–0.86** 0.65 0.51–0.83** 0.69 0.59–0.81** Cognitive Domain ☼ Multivariate models adjusted for: sex, age, poverty (CONEVAL), overweight/obesity, crop field, gestational age. 1. R2 = 0.2230 H-L: Chi 2 = 168.27, p = 0.23; 2. R2 = 0.2353 H-L: Chi 2 = 171.45, p = 0.39; 4. R2 = 0.2457 H-L: Chi 2 = 146.33, p = 0.45. ¥ Conditional models adjusted for: sex, age, poverty (CONEVAL), overweight/obesity, systolic arterial pressure, number of mother’s pregnancies and number of gestation. 2. R2 = 0.4027 H-L: Chi 2 = 188.62 p = 0.26, 4. R2 = 0.4613 H-L:Chi 2 = 166.71 H-L = 0.55. Ø Multivariate models adjusted for: sex, age, poverty (CONEVAL), overweight/obesity, guava production, gestational age, pesticide exposure at the fathers workplace, fathers contact with pesticides. 2. R2 = 0.2345 H-L: Chi 2 = 145.90, p = 0.28; 3. R2 = 0.1583 H-L: Chi 2 = 113.57, p = 0.44; 4. R2 = 0.2718 H-L: Chi 2 = 85.09, p = 0.85. Structural Domain ☼ Multivariate models adjusted for: sex, age, poverty (CONEVAL), overweight/obesity, crop field, gestational age. 2. R2 = 0.2772 H-L:Chi 2 = 182.50, p = 0.08; 3. R2 = 0.3446 H-L: Chi 2 = 162.88, p = 0.44; 4. R2 = 0.3594 H-L: Chi 2 = 163.97, p = 0.39; 5. R2 = 0.4077 H-L:Chi 2 = 170.03, p = 0.37; 6. R2 = 0.3989 Chi 2 = 151.75, p = 0.85; 7. R2 = 0.3119 H-L:Chi 2 = 155.23, p = 0.43; 8. R2 = 0.2752 H-L:Chi 2 = 170.32, p = 0.20. ¥ Conditional models adjusted for: sex, age, poverty (CONEVAL), overweight/obesity, systolic arterial pressure, number of mother’s pregnancy, number of gestation. 1. R2 = 0.4490 H-L: Chi 2 = 192.90, p = 0.19; 2. R2 = 0.4212 H-L: Chi 2 = 185.42, p = 0.22; 3. R2 = 0.5278 H-L: Chi 2 = 191.73, p = 0.14; 4. R2 = 0.6355 H-L: Chi 2 = 195.11, p = 0.15; 5. R2 = 0.5361 H-L: Chi 2 = 199.05, p = 0.12; 6. R2 = 0.5966 H-L: Chi 2 = 210.36, p = 0.06; 7. R2 = 0.4012 H-L: Chi 2 = 183.03, p = 0.23; 8. R2 = 0.4622 H-L: Chi 2 = 183.51, p = 0.24. Ø Multivariate models adjusted for: sex, age, poverty (CONEVAL), overweight/obesity, guava production, gestational age, pesticide exposure at the fathers workplace, and fathers contact with pesticides. 1. R2 = 0.1661 H-L: Chi 2 = 128.42, p = 0.18; 2. R2 = 0.2742 H-L: Chi 2 = 115.42, p = 0.76; 3. R2 = 0.3224 H-L: Chi 2 = 165.72, p = 0.68; 4. R2 = 0.3569 H-L: Chi 2 = 134.03, p = 0.41; 5. R2 = 0.3745 H-L: Chi 2 = 155.8, p = 0.08; 6. R2 = 0.4046 H-L: Chi 2 = 152.73, p = 0.16; 7. R2 = 0.2879 H-L: Chi 2 = 133.70, p = 0.28; 8. R2 = 0.2691 H-L: Chi 2 = 135.81, p = 0.18. *p ≤ 0.05 **p ≤ 0.01 H-L: Hosmer-Lemeshow Test. The preventable fraction of the dimensions that were associated with CKD ranged from 0.09 to 0.18 of the risk, specifically for the dimensions of social harmony, generalized norms and sense of belonging to the community. However, the dimension that had the greatest potential impact was trust for the community in both cases and controls, which means that 0.43 of the risk of having CKD can be prevented if we promote trust is promoted among adolescents in the community, and 0.57 of the remaining risk would be due to other causes (Table 3 ). In the dimensions of the SD, the preventable fraction ranged from 0.15 to 0.34, the dimensions with the greatest potential impact being degree of citizenship for cases and their three controls. For cases and community controls, the domains of collective action and diversity were also added. Thus, the data suggests that 0.40 of the risk of CKD can be prevented if we promote greater participation of adolescents with authorities and/or community leaders to achieve a common goal (degree of civic responsibility: Table 3 ). Table 3 Preventable fraction of the continuous dimensions at the community level of social capital of health with the presence of chronic kidney disease in adolescents Dimension Index Cases n = 96 and School Controls n = 96 Cases n = 96 and Family Controls n = 96 Cases n = 96 and Community Controls n = 96 PF PF PF Cognitive Domain Social Harmony 0.09 Generalized Norms 0.14 0.15 0.18 Sense of Belonging 0.15 Confidence 0.33 0.39 0.43 Structural Domain Participation in organizations 0.30 0.19 Membership of institutions 0.19 0.15 0.26 Frequency of activities 0.29 0.27 0.30 Size of the networks 0.30 0.37 0.34 Collective actions 0.32 0.25 0.34 Degree of civic responsibility 0.35 0.43 0.40 Diversity 0.33 0.23 0.35 Belonging to Groups with Resources 0.27 0.35 0.31 PF: Preventable fraction Ordinal logistic regression models for the association of CKD risk with the SC dimensions showed that in the CD, the dimensions of social harmony, generalized norms and trust were associated with an ORp (proportional odds ratio) ranging from 0.59 to 0.86. By contrast, in the SD the dimensions of attachment to institutions and frequency of action were associated with an ORp ranging from 0.72 to 0.84, all of which were protective factors (Table 4 ). The highest ORp was found in school cases and controls in the dimension of generalized norms (ORp 0.86, 95% CI 0.78–0.95). This result could be interpreted as the probability of adolescents with greater reciprocity (generalized norms) shifting to a CKD stage is 14% lower than in adolescents with lower reciprocity (generalized norms), given that all other variables in the model remain constant (Table 4 ). Table 4 Proportional association strength of continuous dimensions of individual level of social capital in health with the presence of chronic kidney disease in adolescents Dimension Index Cases n = 96 and School Controls n = 96 Ordinal logistic Model☼ Cases n = 96 and Family Controls n = 96 Ordinal logistic Model ¥ Cases n = 96 and Community Controls n = 96 Ordinal logistic Model Ø ORp 95% CI ORp 95% CI ORp 95% CI Cognitive Domain Social harmony (continuous scale) 1 1.12 1.14–1.25* 1.11 1.01–1.22** 1.11 1.007–1.23* Generalized norms (continuous scale) 2 0.86 0.78–0.95** 0.86 0.79–0.94** 0.84 0.77–0.92** Confidence (continuous scale) 3 0.67 0.53–0.85** 0.59 0.47–0.74** 0.60 0.48–0.76** Structural Domain Membership of institutions (continuous scale) 4 0.81 0.74–0.89** 0.84 0.77–0.91** 0.77 0.70–0.85** Frequency of the activities (continuous scale) 5 0.72 0.65–0.80** 0.74 0.67–0.82** 0.74 0.66–0.82** ☼ Ordinal logistic model adjusted for sex, age, overweight/obesity, crop field, gestational age: 1. R2 = 0.10233; 2. R2 = 0.1093; 3. R2 = 0.1181; 4. R2 = 0.2184; 5. R2 = 0.2657. ¥ Ordinal logistic model adjusted for sex, age, poverty (CONEVAL), overweight/obesity, systolic arterial pressure, number of mother’s pregnancy, and number of gestation: 1. R2 = 0.0890; 2. R2 = 0.1090; 3. R2 = 0.1158; 4. R2 = 0.1256; 5. R2 = 0.1677. Ø Ordinal logistic model adjusted for sex, age, poverty (CONEVAL), overweight/obesity, guava production, gestational age, pesticide exposure at the fathers workplace, and fathers contact with pesticides: 1. R2 = 0.0943; 2. R2 = 0.1275; 3. R2 = 0.1602; 4. R2 = 0.1761; 5. R2 = 0.2359. *p ≤ 0.05 **p ≤ 0.01 Discussion In the present study, SC dimensions showed a consistent and significant association with the presence and risk of CKD among adolescents in the state of Aguascalientes. Globally, SC has not been assigned a clear role for the development of CKD, and the few studies, and the few studies carried out have only sought associations with medication adherence ( 31 ) and neighborhood networks ( 32 ), with a limited focus. Given the clear and consistent association between socioeconomic status and the risk of CKD worldwide ( 33 ), the study of SC and its association with the onset and progression of CKD is essential to understand this condition entirely. In terms of the CD of SC, four of the six components of the CD had a significant association with CKD (social harmony, generalized norms, sense of belonging and trust). A similar association was evident for eight of the nine elements of the SD (participation in organizations, attachment to institutions, frequency of actions, size of networks, collective action, degree of civic responsibility, diversity and attachment to groups with resources). However, for the association of SC with CKD risk ( 34 ), the dimensions of social harmony, generalized norms and trust in the CD, and attachment to institutions and frequency of actions in the SD were the most relevant. This research was based on an earlier approach ( 3 ) and proposed measurements ( 5 ) that established two domains: the CD and SD ( 2 ). The SC is multidimensional and to measure it adequately, theoretical approaches must be adhered to and the context in which it will be studied must be considered: adolescent high school students, and the presence and risk of CKD in our study. In health and behavioral research, SC can be explained by the accumulation of lasting network connections that are reliable, reciprocal and derived from a variety of resources, and that help empower a society and its members ( 3 ). The results obtained in this study can be attributed to the mechanisms of SC, which include collective socialization, informal social control, collective efficacy and social support, together with evidence showing that adolescents with CKD, and/or at risk of CKD, need guidance in self-care and self-management to achieve optimal health outcomes ( 35 ). The distribution of sociodemographic and somatometric characteristics of the adolescents in our study was like those reported elsewhere ( 12 ). The level of poverty was assessed using the methodology of the National Council for the Evaluation of Social Development Policy (CONEVAL), presenting four categories of poverty like those described previously ( 36 ). Socioeconomic status is a crucial factor in determining CKD risk, as it has consistently been reported that individuals with low socioeconomic status are at a higher risk of developing this condition ( 32 , 37 ). The factors more strongly (OR ≥ 1.5) associated with the risk for CKD were the proximity of a crop to the home, pesticide exposure at the father's workplace and gestational age, results consistent with those presented elsewhere ( 12 , 38 , 39 ). A comprehensive literature search identified two earlier studies on SC and CKD in adult populations. One of them focused on whether SC helps improve medication adherence in patients with end-stage CKD ( 31 ); and the other was in the context of neighborhood influencing the risk of CKD, with only a limited focus on SC ( 32 ). By contrast, SC studies in adolescent populations have addressed different health problems, the most common being their perception of health ( 40 ), mental health ( 19 – 21 ) and oral health ( 18 ). Regarding the strength of the association between SC dimensions and the presence of CKD, specifically in the CD, this study showed that social harmony was the only dimension associated as a risk factor. This can be explained by SC theory, since if an adolescent’s perception of the community as a place to live is positive, this would represent an ideal social fabric due to the interactions among people who form networks, and the dynamic exchange between individuals and groups. These connections, in turn, create a sense of community in the immediate environment, resulting in a state of comfort where adolescents feel safe and are less likely to take risks ( 41 ). The rest of the CD dimensions, like the seven associated SD dimensions, were protective factors ( 42 ), such that adolescents would reduce the risk of CKD for each unit increase in these SC dimensions. There are dimensions that, in theory, produce an ideal situation that can be explained through the main theories of SC. The measurements obtained may reflect reality due to the plausibility of network theories and social cohesion. Network theory establishes that SC reflects the resources that individuals can access through their social connections. Social cohesion explains that SC is the attribute of a group and a property of the community, the context of which can influence individuals to cooperate or actively participate ( 4 ). In terms of consistency, no evidence was found of studies evaluating the dimensions of SC associated with the presence or risk of CKD in the literature. However, there was evidence of SC as a protective factor ( 43 – 45 ). The potential impact of the SC dimensions that were associated as protective factors against CKD defines the preventable fraction. This represents “the individual risk due to exposure” and it is expressed as the savings or benefit obtained in the rate or risk of disease in those exposed if that exposure is promoted ( 42 ), which in this case can be attributed to the SC dimensions. Thus, it is necessary to analyze the impact of each of the dimensions in terms of cost-effectiveness when implementing a strategy to improve SC in adolescents with CKD, considering the magnitude of the effect or the population it would benefit. The association between SC dimensions and the risk of CKD classified according to KDIGO ( 34 ) was assessed using ordinal logistic regressions. The proportionality assumption was met according to Brant's test (p ≥ 0.05: 28), indicating that the probability of the progression of CKD changing in adolescents is the same while the rest of the variables in the model remain constant. Comparing our results with other studies is difficult because there appears to be no evidence in the literature of studies evaluating the association between SC dimensions and the risk of CKD. Studies of SC with this type of analysis have examined whether income is a variable mediating between SC and subjective well-being ( 46 ) or measuring the impact of income inequality and SC on physical and mental health ( 47 ). Another study evaluated whether national wealth (GDP per capita) moderates the association between SC and self-rated health ( 48 ). Therefore, the lack of studies with a similar design and on a similar population prevents meaningful comparisons from being made. The present study has several strengths, including the validity and reliability of the SC instrument and its constructs, which help mitigate information bias due to misclassification. Consequently, the study is well situated to employ an SC approach to evaluate the association of each SC dimension with the presence and risk of CKD in adolescents. In addition, the preventable fraction was assessed for each dimension with which an association was identified. By contrast the number of cases that had to be included could represent a limitation of the study, as it might lead to a lack of external validity due to the context of the study. In addition, the estimation of the preventable fraction assumes a causal relationship and the feasibility of modifying social capital dimensions, assumptions that should be interpreted with caution when extrapolating the findings to other populations. Conclusion This study assessed the association and the potential impact of the dimensions of SC with the presence and risk of CKD in adolescents. The evidence obtained for these associations will form the basis for future research aimed at deepening our understanding of the mechanisms underlying SC. Moreover, the data highlight the importance of implementing public health interventions that promote the dimensions of SC that have the greatest potential impact on reducing the prevalence of CKD in this population. Abbreviations SC Social Capital CKD Chronic Kidney Disease ORa Adjusted Odds Ratios ORp Proportional Odds Ratio SD Structural Domain CD Cognitive Domain Declarations Ethical approval and consent to participate This study adhered to the Declaration of Helsinki. It is considered low risk, as participants were not subjected to any type of intervention. Ethical approval was obtained from the Ethics Committees of the Hospital General de Zone No.1, IMSS (R-2021-101-06) and the Centenario Hospital Miguel Hidalgo (2022-U-04), Aguascalientes, México. Informed consent was obtained from parents or legal guardians, and adolescents provided written assent after receiving age-appropriate information. All participants were informed about the study objectives, the voluntary nature of participation, confidentiality, and their right to withdraw at any time. Consent for publication Not applicable. Competing interests The authors declare no conflicts of interest. The results presented have not been published previously. Funding This study was conducted without dedicated financial support from public agencies, commercial entities or nonprofit organizations. Author Contribution CQ-V, CAPA and LLTG led the study design. CQ-V, coordinated data collection. CQ-V, CAPA and LLTG conducted statistical analysis. CAPA and LLTG led the interpretation of the findings. CQ-V and CAPA drafted the first manuscript. GTOV, JMAG, and LLTG supervised the interpretation of results and support the preparation and critical revision of the manuscript. All authors reviewed and approved the final version of the manuscript. Acknowledgement Carolina Quiñones-Villalobos, doctoral candidate at the Programa de Doctorado en Ciencias Médicas, Odontológicas y de la Salud, Universidad Nacional Autónoma de México, acknowledges the support of the Consejo Nacional de Ciencia y Tecnología (CONACYT), CVU 701593. The authors thank the health personnel of the Instituto de Servicios de Salud de Aguascalientes and the Instituto Mexicano del Seguro Social for their collaboration and the government of the state of Aguascalientes for its support to this study, and Dr. Brenda Rosario Sandoval Meza (Universidad Nacional Autónoma de México, Facultad de Medicina) for the medical translation and proofreading of this paper. Data Availability The datasets generated and analyzed during the current study contain sensitive adolescent health information and are therefore not publicly available. Data may be obtained from the corresponding author upon reasonable request and subject to ethical restrictions. References Ehsan A, Klaas HS, Bastianen A, Spini D. Social capital and health: A systematic review of systematic reviews. SSM-population health. 2019;8:100425. 10.1016/j.ssmph.2019.100425 . Magro-Montañés B, Pabón‐Carrasco M, Romero‐Castillo R, Ponce‐Blandón JA, Jiménez‐Picón N. 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Subst Use Misuse. 2020;55(12):1993–2001. 10.1080/10826084.2020.1784949 . Solar O, Irwin A. A conceptual framework for action on the social determinants of health. WHO Document Production Services; 2010. https://www.afro.who.int/sites/default/files/2017-06/SDH_conceptual_framework_for_action.pdf Quiñones-Villalobos C, Prado-Aguilar CA, Obrador-Vera GT, Arreola-Guerra JM, Padilla-López J, Alanis-Ocádiz A, Cisneros-García DL, Navarro-Rodriguez DC, Tirado-Gómez LL. Development and validation of a questionnaire to assess the health related Social Capital for Chronic Kidney Disease among Mexican adolescents. PLoS ONE. 2025;20(7):e0328386. 10.1371/journal.pone.0328386 . Hosmer DW, Lemesbow S, Methods. Goodness of fit tests for the multiple logistic regression model. Commun Stat - Theory Methods. 1980;9(10):1043–69. https://doi.org/10.1080/03610928008827941 . Brant R. Assessing proportionality in the proportional odds model for ordinal logistic regression. Biometrics. 1990:1171–8. Miettinen OS. Proportion of disease caused or prevented by a given exposure, trait or intervention. Am J Epidemiol. 1974;99(5):325–32. Miettinen O. Estimability and estimation in case-referent studies. Am J Epidemiol. 1976;103(2):226–35. Parker WM, Ferreira K, Vernon L, Cardone KEJRS, Pharmacy A. The delicate balance of keeping it all together: Using social capital to manage multiple medications for patients on dialysis. Res Social Adm Pharm. 2017;13(4):738–745. • 10.1016/j.sapharm.2016.07.008 Boyle SM, Zhao Y, Chou E, Moore K, Harhay MN. Neighborhood context and kidney disease in Philadelphia. SSM Popul Health. 2020;12:100646. 10.1016/j.ssmph.2020.100646 . Tannor EK, Chika OU, Okpechi IG, editors. The impact of low socioeconomic status on progression of chronic kidney disease in low-and lower middle-income countries. Seminars in Nephrology; 2022: Elsevier. 10.1016/j.semnephrol.2023.151338 Stevens PE, Ahmed SB, Carrero JJ, Foster B, Francis A, Hall RK, et al. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. 2024;105(4):S117–314. de Díaz-González ME, Del Villar-Vilchis M, Guerrero R, Barajas-Valencia VM, Vander-Schaaf EB, de Pomposo A et al. Self-management and health care transition among adolescents and young adults with chronic kidney disease: medical and psychosocial considerations. Advances in chronic kidney disease. 2017;24(6):405-9. • 10.1053/j.ackd.2017.09.010 CONEVAL. Consejo Nacional de Evaluación de la Política de Desarrollo Social (CONEVAL). Medición multidimensional de la pobreza en Aguascalientes 2020 [Available from: https://www.coneval.org.mx/coordinacion/entidades/PublishingImages/Pobreza_2020/Cuadro_1_Aguascalientes.jpg Didsbury M, van Zwieten A, Chen K, James LJ, Francis A, Kim S, et al. The association between socioeconomic disadvantage and parent-rated health in children and adolescents with chronic kidney disease—the Kids with CKD (KCAD) study. Pediatr Nephrol. 2019;34:1237–45. 10.1007/s00467-019-04209-7 . Atkinson MA, Ng DK, Warady BA, Furth SL, Flynn JT. The CKiD study: overview and summary of findings related to kidney disease progression. Pediatr Nephrol. 2021;36:527–38. 10.1007/s00467-019-04458-6 . Chapman E, Haby MM, Illanes E, Sanchez-Viamonte J, Elias V, Reveiz L. Risk factors for chronic kidney disease of non-traditional causes: a systematic review. Rev Panam Salud Publica. 2019;1443:e35. 10.26633/RPSP.2019.35 . Nieuwenhuis J. Neighborhood social capital and adolescents’ individual health development. Social Sci Med. 2020;265:113417. 10.1016/j.socscimed.2020.113417 . De Silva MJ. Context and composition? social capital and maternal mental health in low income countries. London School of Hygiene & Tropical Medicine; 2005. 10.17037/PUBS.00682343 . Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic research: principles and quantitative methods. Wiley; 1991. Sakai-Bizmark R, Richmond TK, Kawachi I, Elliott MN, Davies SL, Emery ST, et al. School social capital and tobacco experimentation among adolescents: Evidence from a cross-classified multilevel, longitudinal analysis. J Adolesc Health. 2020;66(4):431–8. 10.1016/j.jadohealth.2019.10.022 . De Clercq B, Vyncke V, Hublet A, Elgar FJ, Ravens-Sieberer U, Currie C, et al. Social capital and social inequality in adolescents’ health in 601 Flemish communities: A multilevel analysis. Social Sci Med. 2012;74(2):202–10. 10.1016/j.socscimed.2011.10.025 . Jesmin SS, Amin I. Diseases of despair and social capital: findings from a population-based survey on opioid misuse among adolescents. Subst Use Misuse. 2020;55(12):1993–2001. 10.1080/10826084.2020.1784949 . Zhang W. Social capital, income and subjective well-being: evidence in rural China. Heliyon. 2022;8(1). 10.1016/j.heliyon.2021.e08705 . He Y, Zhou L, Li J, Wu J. An empirical analysis of the impact of income inequality and social capital on physical and mental health-take China’s micro-database analysis as an example. Int J Equity Health. 2021;20:1–14. 10.1186/s12939-021-01560-w . Story WT, Glanville JL. Comparing the association between social capital and self-rated health in poor and affluent nations. SSM-population health. 2019;9:100508. 10.1016/j.ssmph.2019.100508 . Additional Declarations No competing interests reported. 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relation to various health issues (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Accordingly, a concept of SC geared toward public health and community development has been established and defined as \u0026ldquo;the characteristics of social organization, such as networks, norms and social trust, that facilitate coordination and cooperation for mutual benefit\u0026rdquo; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The accumulation of SC reconciles individual and collective interests and has been consistently linked to improved health, social and economic outcomes (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Mechanisms through wich SC influences health include: 1) collective socialization, promoting healthy behaviors and information sharing; 2) informal social control, establishing behavioral norms that maintain social order; 3) collective efficacy, enabling access to resources; and 4) social support, that provides emotional support (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSC is measured through structural (SD) and cognitive (CD) domains. SD refers to observable processes and organization, whereas CD captures subjective perceptions of social relations. Both domains assess elements such as cooperation, collective action security an interpersonal trust. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eChronic kidney disease (CKD) has been extensively investigated from clinical perspectives, yet social determinants are equally important, since living and working conditions strongly shape health outcomes. Incorporating this broader view facilitates understanding of the interaction that arise once CKD is diagnosed (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCKD represents a major global health burden, affecting more than 850\u0026nbsp;million people, with projections of 14.5\u0026nbsp;million reaching end-stage CKD by 2030 (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In Aguascalientes (Mexico), prevalence rose from 2,075 cases per million population (pmp) in 2020 to 2,328 pmp in 2022, ranking seventh worldwide (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The distribution is bimodal peaking at ages 20\u0026ndash;40 and 50\u0026ndash;70 years. Remarkably, in the younger group, Aguascalientes records the highest worldwide prevalence, with the cause classified as \u0026ldquo;unknown\u0026rdquo; in 73% of cases (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Screening studies in adolescents revealed an incidence of CKD (Stage I G1A2) of 3.7% (95% confidence Interval -CI 2.1\u0026ndash;5.3) (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStudies in adults have associated SC to CKD related outcomes such as medication adherence (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), transplantation networks (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), and civic participation (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Lack of neighborhood ties has been associated with limited support (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), while reciprocity within communities reduces the risk of chronic diseases such as diabetes or hypertension (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn adolescents, SC has been studied in relation to different health problems, including oral health (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), mental health (\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) and health perception (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Evidence shows that self-rated good health, neighborhood trust, and reciprocity at school (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) were associated with higher SC, and increases in SC were associated with a reduced likelihood of smoking or using opioids (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Hence, these studies indicate that SC is an important resource that helps adolescents improve, cope with and even prevent these problems.\u003c/p\u003e \u003cp\u003eWhile there are studies evaluating the influence of SC on different health problems in the adolescent population, none of them has focused on CKD. The importance of SC in adolescents is that as an intermediate social determinant, it serves to mitigate social inequalities in health by influencing social configurations, and it can drive differences in exposure and vulnerability to conditions that compromise health (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Based on the above, this study aimed to evaluate the strength of the association and the potential impact of the dimensions of SC on individual and on community health, specifically in relation to the presence and risk of CKD in Mexican adolescents.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eAn observational, case-control study was carried out, with a ratio of one case to three controls (school, family, or community members). Cases were adolescents aged 12 to 17 years with incident CKD, defined as albuminuria (albumin\u0026thinsp;\u0026ge;\u0026thinsp;30 mg/g creatinine) and/or a glomerular filtration rate\u0026thinsp;\u0026le;\u0026thinsp;60 ml/min/1.73 m2 in two separate measurements taken at least 3 months apart, and with a percutaneous renal biopsy (KDIGO guidelines). The controls were adolescents aged 12 to 17 years, with no albuminuria (albumin\u0026thinsp;\u0026le;\u0026thinsp;30 mg/g creatinine) or a glomerular filtration rate\u0026thinsp;\u0026ge;\u0026thinsp;60 mL/min/1.73 m\u0026sup2;.\u003c/p\u003e \u003cp\u003eThe study population included adolescents attending public or private secondary schools in three municipalities of Aguascalientes: Rinc\u0026oacute;n de Romos, Calvillo and Aguascalientes. Prior to participation, informed consent was obtained from parents and assent from the adolescents. Those without consent, unwilling to participate or no longer residing in the municipalities were excluded.\u003c/p\u003e \u003cp\u003eThe Aguascalientes Institute of Education provided enrollment list from 130 secondary schools. From these 47 schools were randomly selected, representing a total of 17,355 students in their third year of secondary education. A random sample of 3,000 adolescents was drawn to identify potential cases and controls.\u003c/p\u003e \u003cp\u003eScreening was performed to detect cases meeting CKD diagnostic criteria. Controls were chosen in three ways: 1) a classmate from the same school year, 2) a family member within two years of age and any degree of consanguinity, and 3) a community peer residing within a 9 block radios of the cases home, identified through systematic house selection.\u003c/p\u003e \u003cp\u003eA specific questionnaire was developed to assess the validity and reliability of social capital related to CKD in Mexican adolescents, showing an adequate content and apparent validity. Construct validity indicated a construct validity of 72.78% of the explained variance for the CD, and 83.20 for the SD. Confirmatory analysis returned a chi-squared value of 142.99 (p\u0026thinsp;=\u0026thinsp;0.05), a CFI of 0.97, a TLI of 0.96, a RMSEA of 0.040 and a SRMR of 0.07 for the CD. Similarly, a chi-squared of 408.296 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), a CFI of 0.98, a TLI of 0.97, a RMSEA 0.03 and a SRMR of 0.06 were returned for the SD. Criterium validity showed a mild to strongly significant correlation (p\u0026thinsp;\u0026le;\u0026thinsp;0.001) among items and dimensions within each domain. Cronbach\u0026rsquo;s alpha was 0.84 and 0.94 for the CD and SD, respectively (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAll the interviews were conducted out face-to-face by trained interviewers using a standardized questionnaire of eight sections: personal details, sociodemographic characteristics, medical care, patient measurements, laboratory results, degree of wealth/poverty, CKD risk factors, and the SC instrument. The instrument for assessing SC and CKD among Mexican adolescents was previously standardized and published (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e Prior to participation, informed consent was obtained from parents or legal guardians, and adolescents provided written assent after receiving age-appropriate information. All participants were informed about the study objectives, the voluntary nature of participation, confidentiality, and their right to withdraw at any time.\u003c/p\u003e \u003cp\u003eFor the statistical analysis, the study population was first described to evaluate the distribution of variables across cases and controls. Central tendency measures (mean and standard deviation, or median and interquartile range) were used as appropriate. Dichotomous and ordinal variables were described using absolute frequencies and percentages. Group comparisons were performed using Pearson\u0026rsquo;s chi-square test and Student\u0026rsquo;s t-test. To assess associations, binary logistic regression was used to estimate adjusted odds ratios (ORs) between the presence of CKD and SC dimensions. The variables included in the models met the criteria for confounding variables. Model selection was guided by the Akaike Information Criterion (AIC), goodness-of-fit was tested with the Hosmer-Lemeshow test (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo assess the association between CKD risk and SC dimensions, proportional Ors were estimated using ordinal logistic regression. Proportionality was tested with the likelihood ratio and Brand tests (p\u0026thinsp;\u0026ge;\u0026thinsp;0.05) (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). The potential impact of SC was expressed through ORa (1 \u0026ndash; ORa), thereby obtaining the preventable fraction (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 96 cases and 288 controls were included in the study. There were no significant differences between the cases and the school, family, and community controls, indicating that these groups were homogeneous. The average age of the participants was 14.9 years, and there were no significant differences in gender distribution in all four groups. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic and clinical characteristics of the adolescents studied\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCases\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;96\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControls\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSchool n\u0026thinsp;=\u0026thinsp;96\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFamily n\u0026thinsp;=\u0026thinsp;96\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCommunity n\u0026thinsp;=\u0026thinsp;96\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (44.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47 (48.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44 (45.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e49 (51.04)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53 (55.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (51.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52 (54.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47 (48.96)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (߂ \u0026plusmn; DS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.88\u0026thinsp;\u0026plusmn;\u0026thinsp;2.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel of Poverty☼\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot poor nor vulnerable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (40.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (17.71)**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (13.54)**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17 (17.71)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultidimensional poverty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (13.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (13.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (14.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25 (26.04)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVulnerable due to shortages\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43 (44.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (61.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66 (68.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e49 (51.04)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVulnerable due to income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (7.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (3.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (5.21)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbuminuria (median\u0026thinsp;\u0026plusmn;\u0026thinsp;IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65.4(41.9\u0026ndash;163)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.55 (5.3\u0026ndash;12.4)**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.6 (5.9\u0026ndash;11.7)**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (5.2\u0026ndash;13.85)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSize (median\u0026thinsp;\u0026plusmn;\u0026thinsp;IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e162 (158\u0026ndash;168)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e164 (157\u0026ndash;167)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e162 (158\u0026ndash;168)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e162 (158\u0026ndash;167)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP. Size (median\u0026thinsp;\u0026plusmn;\u0026thinsp;IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (25\u0026ndash;66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.5 (21\u0026ndash;64.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (18\u0026ndash;62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32 (16.5\u0026ndash;53.5)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWeight (median\u0026thinsp;\u0026plusmn;\u0026thinsp;IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51.85 (45.35\u0026ndash;62.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.02 (51\u0026ndash;63.72)**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.95 (50.52\u0026ndash;66.85)**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e56.76 (50.05\u0026ndash;67.85)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP. weight (median\u0026thinsp;\u0026plusmn;\u0026thinsp;IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (20.5\u0026ndash;80.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69 (36\u0026ndash;83.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69 (39\u0026ndash;87.5)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67 (32\u0026ndash;89)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWaist (median\u0026thinsp;\u0026plusmn;\u0026thinsp;IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73 (66-77.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.75 (69\u0026ndash;79.5)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76 (68.5\u0026ndash;81)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e74 (67.5\u0026ndash;83)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP. Waist (median\u0026thinsp;\u0026plusmn;\u0026thinsp;IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71.5 (34.5\u0026ndash;77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77 (41.5\u0026ndash;88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77 (38\u0026ndash;91)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e74.5 (38\u0026ndash;92)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (median\u0026thinsp;\u0026plusmn;\u0026thinsp;IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.6 (17.4\u0026ndash;22.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.5 (19.55\u0026ndash;24.25)**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.75 (19.05\u0026ndash;24.85)**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.75 (19.55\u0026ndash;26)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP. BMI (median\u0026thinsp;\u0026plusmn;\u0026thinsp;IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52 (19\u0026ndash;81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78 (44.5\u0026ndash;88.5)**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78 (37.5\u0026ndash;89)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47.5 (71\u0026ndash;94)**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal weight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78 (81.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66 (68.75)**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64 (66.77)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e63 (65.62)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (5.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (21.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (13.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (9.38)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObese\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (13.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (9.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (19.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24 (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSAP (median\u0026thinsp;\u0026plusmn;\u0026thinsp;IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e110 (100\u0026ndash;117)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e110 (100\u0026ndash;116)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e110 (100\u0026ndash;120)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e110 (106.5\u0026ndash;120)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDAP (median\u0026thinsp;\u0026plusmn;\u0026thinsp;IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70 (60\u0026ndash;74.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70 (64\u0026ndash;77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70 (70\u0026ndash;80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e71 (70\u0026ndash;80)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e*p\u0026thinsp;\u0026le;\u0026thinsp;0.05, ** p\u0026thinsp;\u0026le;\u0026thinsp;0.01, Pearson\u0026rsquo;s chi squared, Student t for independent samples, Mann-Whitney U test. Abbreviations: P, Percentage, BMI, Body Mass Index; SAP, Systolic arterial pressure; DAP, Diastolic arterial pressure. ☼ National Council for the Evaluation of Social Development Policy (CONEVAL) methodological evaluation.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePoverty levels indicated social vulnerability, with significant differences among groups (cases: 44.8%; school: 61.4%; family: 68.7%; community: 51.04%; p\u0026thinsp;\u0026le;\u0026thinsp;0.05). Median albuminuria was higher in cases (65.4mg/g; IQR 41.9\u0026ndash;163) than in controls (7.6-8mg/g; p\u0026thinsp;\u0026le;\u0026thinsp;0.01). Normal body mass index (BMI) was more frequent in cases, whereas controls was lower BMI (p\u0026thinsp;\u0026le;\u0026thinsp;0.05). Systolic blood pressure was significantly higher in family controls (mean 110mmHg; IQR 100\u0026ndash;120; p\u0026thinsp;\u0026le;\u0026thinsp;0.05; Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCKD was associated with three of the six dimensions of the CD of SC, ranging from an ORa of 0.57 to a maximum ORa of 0.86, the latter found between the cases and the school controls. The ORa of 0.86 associated with the generalized norms (reciprocity) dimension (95% CI 0.78\u0026ndash;0.96; p\u0026thinsp;\u0026le;\u0026thinsp;0.01) meaning that adolescents with greater reciprocity have a 14% lower risk of having CKD for each unit of the index relative to adolescents with a lower reciprocity (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). By contrast, 8 of the 9 dimensions of the SD proved to be protective factors, with an ORa ranging from 0.63 to 0.85. Among the school cases and controls, adolescents with greater social contact with other peers and/or neighbors (network size) had a 30% lower risk of having CKD for each unit of the index relative to adolescents with less social contact with other peers and/or neighbors (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAdjusted strength of the associations in the continuous dimension of social capital of health with the presence of chronic kidney disease in adolescents\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDimension Index\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCases n\u0026thinsp;=\u0026thinsp;96\u003c/p\u003e \u003cp\u003eand School Controls n\u0026thinsp;=\u0026thinsp;96\u003c/p\u003e \u003cp\u003eMultivariate model☼\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eCases n\u0026thinsp;=\u0026thinsp;96\u003c/p\u003e \u003cp\u003eand Family Controls n\u0026thinsp;=\u0026thinsp;96\u003c/p\u003e \u003cp\u003eConditional Model m\u0026yen;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eCases n\u0026thinsp;=\u0026thinsp;96\u003c/p\u003e \u003cp\u003eand Community Controls n\u0026thinsp;=\u0026thinsp;96\u003c/p\u003e \u003cp\u003eMultivariate model \u0026Oslash;\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eORa\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eORa\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eORa\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCognitive Domain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial harmony (continuous scale)\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.003\u0026ndash;1.24*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneralized norms (continuous scale)\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.78\u0026ndash;0.96**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.75\u0026ndash;0.96**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.75\u0026ndash;0.90**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSense of belonging (continuous scale)\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.73\u0026ndash;0.99*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConfidence (continuous scale)\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.51\u0026ndash;0.88**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.46\u0026ndash;0.83**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.44\u0026ndash;0.74**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStructural Domain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipation in organizations (continuous scale)\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.56\u0026ndash;0.88**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.69\u0026ndash;0.95*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMembership of institutions (continuous scale)\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.73\u0026ndash;0.89**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.77\u0026ndash;0.95**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.67\u0026ndash;0.83**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequency of the activities (continuous scale)\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.63\u0026ndash;0.81**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.63\u0026ndash;0.86**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.62\u0026ndash;0.80**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSize of the networks (continuous scale)\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.61\u0026ndash;0.80**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.49\u0026ndash;0.81**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.58\u0026ndash;0.76**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollective actions (continuous scale)\u003csup\u003e5\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.59\u0026ndash;0.77**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.65\u0026ndash;0.86**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.58\u0026ndash;0.75**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDegree of civic responsibility (continuous scale)\u003csup\u003e6\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.56\u0026ndash;0.75**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.43\u0026ndash;0.76**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.51\u0026ndash;0.70**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiversity (continuous scale)\u003csup\u003e7\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.57\u0026ndash;0.80**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.63\u0026ndash;0.95**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.54\u0026ndash;0.77**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBelonging to groups with resources (continuous scale)\u003csup\u003e8\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.63\u0026ndash;0.86**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.51\u0026ndash;0.83**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.59\u0026ndash;0.81**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eCognitive Domain ☼ Multivariate models adjusted for: sex, age, poverty (CONEVAL), overweight/obesity, crop field, gestational age. 1. R2\u0026thinsp;=\u0026thinsp;0.2230 H-L: Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;168.27, p\u0026thinsp;=\u0026thinsp;0.23; 2. R2\u0026thinsp;=\u0026thinsp;0.2353 H-L: Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;171.45, p\u0026thinsp;=\u0026thinsp;0.39; 4. R2\u0026thinsp;=\u0026thinsp;0.2457 H-L: Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;146.33, p\u0026thinsp;=\u0026thinsp;0.45.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u0026yen; Conditional models adjusted for: sex, age, poverty (CONEVAL), overweight/obesity, systolic arterial pressure, number of mother\u0026rsquo;s pregnancies and number of gestation. 2. R2\u0026thinsp;=\u0026thinsp;0.4027 H-L: Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;188.62 p\u0026thinsp;=\u0026thinsp;0.26, 4. R2\u0026thinsp;=\u0026thinsp;0.4613 H-L:Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;166.71 H-L\u0026thinsp;=\u0026thinsp;0.55.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u0026Oslash; Multivariate models adjusted for: sex, age, poverty (CONEVAL), overweight/obesity, guava production, gestational age, pesticide exposure at the fathers workplace, fathers contact with pesticides. 2. R2\u0026thinsp;=\u0026thinsp;0.2345 H-L: Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;145.90, p\u0026thinsp;=\u0026thinsp;0.28; 3. R2\u0026thinsp;=\u0026thinsp;0.1583 H-L: Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;113.57, p\u0026thinsp;=\u0026thinsp;0.44; 4. R2\u0026thinsp;=\u0026thinsp;0.2718 H-L: Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;85.09, p\u0026thinsp;=\u0026thinsp;0.85.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eStructural Domain ☼ Multivariate models adjusted for: sex, age, poverty (CONEVAL), overweight/obesity, crop field, gestational age. 2. R2\u0026thinsp;=\u0026thinsp;0.2772 H-L:Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;182.50, p\u0026thinsp;=\u0026thinsp;0.08; 3. R2\u0026thinsp;=\u0026thinsp;0.3446 H-L: Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;162.88, p\u0026thinsp;=\u0026thinsp;0.44; 4. R2\u0026thinsp;=\u0026thinsp;0.3594 H-L: Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;163.97, p\u0026thinsp;=\u0026thinsp;0.39; 5. R2\u0026thinsp;=\u0026thinsp;0.4077 H-L:Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;170.03, p\u0026thinsp;=\u0026thinsp;0.37; 6. R2\u0026thinsp;=\u0026thinsp;0.3989 Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;151.75, p\u0026thinsp;=\u0026thinsp;0.85; 7. R2\u0026thinsp;=\u0026thinsp;0.3119 H-L:Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;155.23, p\u0026thinsp;=\u0026thinsp;0.43; 8. R2\u0026thinsp;=\u0026thinsp;0.2752 H-L:Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;170.32, p\u0026thinsp;=\u0026thinsp;0.20.\u003c/p\u003e \u003cp\u003e\u0026yen; Conditional models adjusted for: sex, age, poverty (CONEVAL), overweight/obesity, systolic arterial pressure, number of mother\u0026rsquo;s pregnancy, number of gestation. 1. R2\u0026thinsp;=\u0026thinsp;0.4490 H-L: Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;192.90, p\u0026thinsp;=\u0026thinsp;0.19; 2. R2\u0026thinsp;=\u0026thinsp;0.4212 H-L: Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;185.42, p\u0026thinsp;=\u0026thinsp;0.22; 3. R2\u0026thinsp;=\u0026thinsp;0.5278 H-L: Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;191.73, p\u0026thinsp;=\u0026thinsp;0.14; 4. R2\u0026thinsp;=\u0026thinsp;0.6355 H-L: Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;195.11, p\u0026thinsp;=\u0026thinsp;0.15; 5. R2\u0026thinsp;=\u0026thinsp;0.5361 H-L: Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;199.05, p\u0026thinsp;=\u0026thinsp;0.12; 6. R2\u0026thinsp;=\u0026thinsp;0.5966 H-L: Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;210.36, p\u0026thinsp;=\u0026thinsp;0.06; 7. R2\u0026thinsp;=\u0026thinsp;0.4012 H-L: Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;183.03, p\u0026thinsp;=\u0026thinsp;0.23; 8. R2\u0026thinsp;=\u0026thinsp;0.4622 H-L: Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;183.51, p\u0026thinsp;=\u0026thinsp;0.24.\u003c/p\u003e \u003cp\u003e\u0026Oslash; Multivariate models adjusted for: sex, age, poverty (CONEVAL), overweight/obesity, guava production, gestational age, pesticide exposure at the fathers workplace, and fathers contact with pesticides. 1. R2\u0026thinsp;=\u0026thinsp;0.1661 H-L: Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;128.42, p\u0026thinsp;=\u0026thinsp;0.18; 2. R2\u0026thinsp;=\u0026thinsp;0.2742 H-L: Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;115.42, p\u0026thinsp;=\u0026thinsp;0.76; 3. R2\u0026thinsp;=\u0026thinsp;0.3224 H-L: Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;165.72, p\u0026thinsp;=\u0026thinsp;0.68; 4. R2\u0026thinsp;=\u0026thinsp;0.3569 H-L: Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;134.03, p\u0026thinsp;=\u0026thinsp;0.41; 5. R2\u0026thinsp;=\u0026thinsp;0.3745 H-L: Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;155.8, p\u0026thinsp;=\u0026thinsp;0.08; 6. R2\u0026thinsp;=\u0026thinsp;0.4046 H-L: Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;152.73, p\u0026thinsp;=\u0026thinsp;0.16; 7. R2\u0026thinsp;=\u0026thinsp;0.2879 H-L: Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;133.70, p\u0026thinsp;=\u0026thinsp;0.28; 8. R2\u0026thinsp;=\u0026thinsp;0.2691 H-L: Chi\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;135.81, p\u0026thinsp;=\u0026thinsp;0.18.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e*p\u0026thinsp;\u0026le;\u0026thinsp;0.05 **p\u0026thinsp;\u0026le;\u0026thinsp;0.01 H-L: Hosmer-Lemeshow Test.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe preventable fraction of the dimensions that were associated with CKD ranged from 0.09 to 0.18 of the risk, specifically for the dimensions of social harmony, generalized norms and sense of belonging to the community. However, the dimension that had the greatest potential impact was trust for the community in both cases and controls, which means that 0.43 of the risk of having CKD can be prevented if we promote trust is promoted among adolescents in the community, and 0.57 of the remaining risk would be due to other causes (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). In the dimensions of the SD, the preventable fraction ranged from 0.15 to 0.34, the dimensions with the greatest potential impact being degree of citizenship for cases and their three controls. For cases and community controls, the domains of collective action and diversity were also added. Thus, the data suggests that 0.40 of the risk of CKD can be prevented if we promote greater participation of adolescents with authorities and/or community leaders to achieve a common goal (degree of civic responsibility: Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePreventable fraction of the continuous dimensions at the community level of social capital of health with the presence of chronic kidney disease in adolescents\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDimension Index\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCases n\u0026thinsp;=\u0026thinsp;96\u003c/p\u003e \u003cp\u003eand School Controls n\u0026thinsp;=\u0026thinsp;96\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCases n\u0026thinsp;=\u0026thinsp;96\u003c/p\u003e \u003cp\u003eand Family Controls n\u0026thinsp;=\u0026thinsp;96\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCases n\u0026thinsp;=\u0026thinsp;96\u003c/p\u003e \u003cp\u003eand Community Controls n\u0026thinsp;=\u0026thinsp;96\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePF\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCognitive Domain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial Harmony\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneralized Norms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSense of Belonging\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConfidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStructural Domain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipation in organizations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMembership of institutions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequency of activities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSize of the networks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollective actions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDegree of civic responsibility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBelonging to Groups with Resources\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003ePF: Preventable fraction\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOrdinal logistic regression models for the association of CKD risk with the SC dimensions showed that in the CD, the dimensions of social harmony, generalized norms and trust were associated with an ORp (proportional odds ratio) ranging from 0.59 to 0.86. By contrast, in the SD the dimensions of attachment to institutions and frequency of action were associated with an ORp ranging from 0.72 to 0.84, all of which were protective factors (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The highest ORp was found in school cases and controls in the dimension of generalized norms (ORp 0.86, 95% CI 0.78\u0026ndash;0.95). This result could be interpreted as the probability of adolescents with greater reciprocity (generalized norms) shifting to a CKD stage is 14% lower than in adolescents with lower reciprocity (generalized norms), given that all other variables in the model remain constant (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eProportional association strength of continuous dimensions of individual level of social capital in health with the presence of chronic kidney disease in adolescents\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDimension Index\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCases n\u0026thinsp;=\u0026thinsp;96\u003c/p\u003e \u003cp\u003eand School Controls n\u0026thinsp;=\u0026thinsp;96\u003c/p\u003e \u003cp\u003eOrdinal logistic Model☼\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eCases n\u0026thinsp;=\u0026thinsp;96\u003c/p\u003e \u003cp\u003eand Family Controls n\u0026thinsp;=\u0026thinsp;96\u003c/p\u003e \u003cp\u003eOrdinal logistic Model \u0026yen;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eCases n\u0026thinsp;=\u0026thinsp;96\u003c/p\u003e \u003cp\u003eand Community Controls n\u0026thinsp;=\u0026thinsp;96\u003c/p\u003e \u003cp\u003eOrdinal logistic Model \u0026Oslash;\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eORp\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eORp\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eORp\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCognitive Domain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial harmony (continuous scale)\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.14\u0026ndash;1.25*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.01\u0026ndash;1.22**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.007\u0026ndash;1.23*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGeneralized norms (continuous scale)\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.78\u0026ndash;0.95**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.79\u0026ndash;0.94**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.77\u0026ndash;0.92**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConfidence (continuous scale)\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.53\u0026ndash;0.85**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.47\u0026ndash;0.74**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.48\u0026ndash;0.76**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStructural Domain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMembership of institutions (continuous scale)\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.74\u0026ndash;0.89**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.77\u0026ndash;0.91**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.70\u0026ndash;0.85**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequency of the activities (continuous scale)\u003csup\u003e5\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.65\u0026ndash;0.80**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.67\u0026ndash;0.82**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.66\u0026ndash;0.82**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e☼ Ordinal logistic model adjusted for sex, age, overweight/obesity, crop field, gestational age: 1. R2\u0026thinsp;=\u0026thinsp;0.10233; 2. R2\u0026thinsp;=\u0026thinsp;0.1093; 3. R2\u0026thinsp;=\u0026thinsp;0.1181; 4. R2\u0026thinsp;=\u0026thinsp;0.2184; 5. R2\u0026thinsp;=\u0026thinsp;0.2657.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u0026yen; Ordinal logistic model adjusted for sex, age, poverty (CONEVAL), overweight/obesity, systolic arterial pressure, number of mother\u0026rsquo;s pregnancy, and number of gestation: 1. R2\u0026thinsp;=\u0026thinsp;0.0890; 2. R2\u0026thinsp;=\u0026thinsp;0.1090; 3. R2\u0026thinsp;=\u0026thinsp;0.1158; 4. R2\u0026thinsp;=\u0026thinsp;0.1256; 5. R2\u0026thinsp;=\u0026thinsp;0.1677.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u0026Oslash; Ordinal logistic model adjusted for sex, age, poverty (CONEVAL), overweight/obesity, guava production, gestational age, pesticide exposure at the fathers workplace, and fathers contact with pesticides: 1. R2\u0026thinsp;=\u0026thinsp;0.0943; 2. R2\u0026thinsp;=\u0026thinsp;0.1275; 3. R2\u0026thinsp;=\u0026thinsp;0.1602; 4. R2\u0026thinsp;=\u0026thinsp;0.1761; 5. R2\u0026thinsp;=\u0026thinsp;0.2359.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e*p\u0026thinsp;\u0026le;\u0026thinsp;0.05 **p\u0026thinsp;\u0026le;\u0026thinsp;0.01\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn the present study, SC dimensions showed a consistent and significant association with the presence and risk of CKD among adolescents in the state of Aguascalientes. Globally, SC has not been assigned a clear role for the development of CKD, and the few studies, and the few studies carried out have only sought associations with medication adherence (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) and neighborhood networks (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), with a limited focus. Given the clear and consistent association between socioeconomic status and the risk of CKD worldwide (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e), the study of SC and its association with the onset and progression of CKD is essential to understand this condition entirely.\u003c/p\u003e \u003cp\u003eIn terms of the CD of SC, four of the six components of the CD had a significant association with CKD (social harmony, generalized norms, sense of belonging and trust). A similar association was evident for eight of the nine elements of the SD (participation in organizations, attachment to institutions, frequency of actions, size of networks, collective action, degree of civic responsibility, diversity and attachment to groups with resources). However, for the association of SC with CKD risk (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), the dimensions of social harmony, generalized norms and trust in the CD, and attachment to institutions and frequency of actions in the SD were the most relevant.\u003c/p\u003e \u003cp\u003eThis research was based on an earlier approach (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) and proposed measurements (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) that established two domains: the CD and SD (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The SC is multidimensional and to measure it adequately, theoretical approaches must be adhered to and the context in which it will be studied must be considered: adolescent high school students, and the presence and risk of CKD in our study. In health and behavioral research, SC can be explained by the accumulation of lasting network connections that are reliable, reciprocal and derived from a variety of resources, and that help empower a society and its members (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The results obtained in this study can be attributed to the mechanisms of SC, which include collective socialization, informal social control, collective efficacy and social support, together with evidence showing that adolescents with CKD, and/or at risk of CKD, need guidance in self-care and self-management to achieve optimal health outcomes (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe distribution of sociodemographic and somatometric characteristics of the adolescents in our study was like those reported elsewhere (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). The level of poverty was assessed using the methodology of the National Council for the Evaluation of Social Development Policy (CONEVAL), presenting four categories of poverty like those described previously (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Socioeconomic status is a crucial factor in determining CKD risk, as it has consistently been reported that individuals with low socioeconomic status are at a higher risk of developing this condition (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). The factors more strongly (OR\u0026thinsp;\u0026ge;\u0026thinsp;1.5) associated with the risk for CKD were the proximity of a crop to the home, pesticide exposure at the father's workplace and gestational age, results consistent with those presented elsewhere (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA comprehensive literature search identified two earlier studies on SC and CKD in adult populations. One of them focused on whether SC helps improve medication adherence in patients with end-stage CKD (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e); and the other was in the context of neighborhood influencing the risk of CKD, with only a limited focus on SC (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). By contrast, SC studies in adolescent populations have addressed different health problems, the most common being their perception of health (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e), mental health (\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) and oral health (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRegarding the strength of the association between SC dimensions and the presence of CKD, specifically in the CD, this study showed that social harmony was the only dimension associated as a risk factor. This can be explained by SC theory, since if an adolescent\u0026rsquo;s perception of the community as a place to live is positive, this would represent an ideal social fabric due to the interactions among people who form networks, and the dynamic exchange between individuals and groups. These connections, in turn, create a sense of community in the immediate environment, resulting in a state of comfort where adolescents feel safe and are less likely to take risks (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). The rest of the CD dimensions, like the seven associated SD dimensions, were protective factors (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e), such that adolescents would reduce the risk of CKD for each unit increase in these SC dimensions.\u003c/p\u003e \u003cp\u003eThere are dimensions that, in theory, produce an ideal situation that can be explained through the main theories of SC. The measurements obtained may reflect reality due to the plausibility of network theories and social cohesion. Network theory establishes that SC reflects the resources that individuals can access through their social connections. Social cohesion explains that SC is the attribute of a group and a property of the community, the context of which can influence individuals to cooperate or actively participate (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). In terms of consistency, no evidence was found of studies evaluating the dimensions of SC associated with the presence or risk of CKD in the literature. However, there was evidence of SC as a protective factor (\u003cspan additionalcitationids=\"CR44\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe potential impact of the SC dimensions that were associated as protective factors against CKD defines the preventable fraction. This represents \u0026ldquo;the individual risk due to exposure\u0026rdquo; and it is expressed as the savings or benefit obtained in the rate or risk of disease in those exposed if that exposure is promoted (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e), which in this case can be attributed to the SC dimensions. Thus, it is necessary to analyze the impact of each of the dimensions in terms of cost-effectiveness when implementing a strategy to improve SC in adolescents with CKD, considering the magnitude of the effect or the population it would benefit.\u003c/p\u003e \u003cp\u003eThe association between SC dimensions and the risk of CKD classified according to KDIGO (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e) was assessed using ordinal logistic regressions. The proportionality assumption was met according to Brant's test (p\u0026thinsp;\u0026ge;\u0026thinsp;0.05: 28), indicating that the probability of the progression of CKD changing in adolescents is the same while the rest of the variables in the model remain constant. Comparing our results with other studies is difficult because there appears to be no evidence in the literature of studies evaluating the association between SC dimensions and the risk of CKD. Studies of SC with this type of analysis have examined whether income is a variable mediating between SC and subjective well-being (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e) or measuring the impact of income inequality and SC on physical and mental health (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). Another study evaluated whether national wealth (GDP per capita) moderates the association between SC and self-rated health (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). Therefore, the lack of studies with a similar design and on a similar population prevents meaningful comparisons from being made.\u003c/p\u003e \u003cp\u003eThe present study has several strengths, including the validity and reliability of the SC instrument and its constructs, which help mitigate information bias due to misclassification. Consequently, the study is well situated to employ an SC approach to evaluate the association of each SC dimension with the presence and risk of CKD in adolescents. In addition, the preventable fraction was assessed for each dimension with which an association was identified. By contrast the number of cases that had to be included could represent a limitation of the study, as it might lead to a lack of external validity due to the context of the study. In addition, the estimation of the preventable fraction assumes a causal relationship and the feasibility of modifying social capital dimensions, assumptions that should be interpreted with caution when extrapolating the findings to other populations.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study assessed the association and the potential impact of the dimensions of SC with the presence and risk of CKD in adolescents. The evidence obtained for these associations will form the basis for future research aimed at deepening our understanding of the mechanisms underlying SC. Moreover, the data highlight the importance of implementing public health interventions that promote the dimensions of SC that have the greatest potential impact on reducing the prevalence of CKD in this population.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eSC Social Capital\u003c/p\u003e\u003cp\u003eCKD Chronic Kidney Disease\u003c/p\u003e\u003cp\u003eORa Adjusted Odds Ratios\u003c/p\u003e\u003cp\u003eORp Proportional Odds Ratio\u003c/p\u003e\u003cp\u003eSD Structural Domain\u003c/p\u003e\u003cp\u003eCD Cognitive Domain\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e \u003c/p\u003e\u003cp\u003e This study adhered to the Declaration of Helsinki. It is considered low risk, as participants were not subjected to any type of intervention.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e Ethical approval was obtained from the Ethics Committees of the Hospital General de Zone No.1, IMSS (R-2021-101-06) and the Centenario Hospital Miguel Hidalgo (2022-U-04), Aguascalientes, México.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eInformed consent\u003c/strong\u003e \u003c/p\u003e\u003cp\u003ewas obtained from parents or legal guardians, and adolescents provided written assent after receiving age-appropriate information. All participants were informed about the study objectives, the voluntary nature of participation, confidentiality, and their right to withdraw at any time.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eNot applicable.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e\u003cp\u003e \u003c/p\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare no conflicts of interest. The results presented have not been published previously.\u003c/p\u003e \u003cp\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study was conducted without dedicated financial support from public agencies, commercial entities or nonprofit organizations.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eCQ-V, CAPA and LLTG led the study design. CQ-V, coordinated data collection. CQ-V, CAPA and LLTG conducted statistical analysis. CAPA and LLTG led the interpretation of the findings. CQ-V and CAPA drafted the first manuscript. GTOV, JMAG, and LLTG supervised the interpretation of results and support the preparation and critical revision of the manuscript. All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eCarolina Quiñones-Villalobos, doctoral candidate at the Programa de Doctorado en Ciencias Médicas, Odontológicas y de la Salud, Universidad Nacional Autónoma de México, acknowledges the support of the Consejo Nacional de Ciencia y Tecnología (CONACYT), CVU 701593. The authors thank the health personnel of the Instituto de Servicios de Salud de Aguascalientes and the Instituto Mexicano del Seguro Social for their collaboration and the government of the state of Aguascalientes for its support to this study, and Dr. Brenda Rosario Sandoval Meza (Universidad Nacional Autónoma de México, Facultad de Medicina) for the medical translation and proofreading of this paper.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and analyzed during the current study contain sensitive adolescent health information and are therefore not publicly available. Data may be obtained from the corresponding author upon reasonable request and subject to ethical restrictions.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eEhsan A, Klaas HS, Bastianen A, Spini D. Social capital and health: A systematic review of systematic reviews. 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SSM-population health. 2019;9:100508. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.ssmph.2019.100508\u003c/span\u003e\u003cspan address=\"10.1016/j.ssmph.2019.100508\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"social capital, chronic kidney disease, adolescents, social determinants of health, preventable fraction","lastPublishedDoi":"10.21203/rs.3.rs-8311858/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8311858/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSocial capital (SC) is a recognized social determinant of health, and its influence chronic kidney disease (CKD) among adolescents remains poorly explored. Understanding this association may help identify modifiable social factors that shape early kidney health.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA case-control study involving 96 adolescents with CKD (aged 12 to 17 years) and 288 adolescents without CKD (controls: school children, family members, and community members). Data was collected using instruments to assess SC, social deprivation, and CKD risk factors. Associations between SC dimensions and CKD presence were analyzed using binary logistic regression (adjusted odds ratios, ORa), while CKD risk levels were examined with ordinal logistic regression (proportional odds ratio, ORp). The preventable fraction was estimated to evaluate the potential impact of protective SC dimensions.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study sample was 55.5% female, with a mean age of 14.9 years. Eleven of fifteen SC dimensions showed a significant protective association with CKD presence (ORa 0.58\u0026ndash;0.85), and four dimensions were associated with reduced CKD risk (ORp 0.59\u0026ndash;0.86). The preventable fraction for these protective dimensions ranged from 0.14 to 0.43, indicating a probable potential for prevention through social interventions.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eHigher levels of social capital were consistently associated with lower CKD risk among adolescents. These findings suggest that strengthening the SC dimensions could serve as innovative public health strategies to reduce CKD prevalence and promote adolescent health.\u003c/p\u003e","manuscriptTitle":"Dimensions of Social Capital Associated with the Presence and Risk of Chronic Kidney Disease in Adolescents","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-22 13:41:12","doi":"10.21203/rs.3.rs-8311858/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-11T07:34:34+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-01T13:31:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"106922723777828176812102403832378858817","date":"2026-02-01T11:41:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-31T08:55:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"119495874850609099910425560861529089604","date":"2026-01-25T13:58:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-20T13:54:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-06T13:29:04+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-30T12:17:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-30T00:41:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-12-30T00:35:50+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5085f3ce-b2c5-42eb-9dd0-fab091df59f4","owner":[],"postedDate":"January 22nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-02T04:53:21+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-22 13:41:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8311858","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8311858","identity":"rs-8311858","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}