Abstract Body (Do not enter title and authors here): Introduction: Peripheral arterial disease (PAD) affects approximately 21 million people in the United States and will rise by 2030. Individuals with chronic kidney disease (CKD) are at elevated risk for developing PAD. Emerging evidence points to a link between social determinants of health (SDOH) and PAD incidence; yet less is known about this relationship in people with CKD.

Hypothesis: We hypothesized that individuals who experience adverse SDOH are at an increased risk of incident PAD.

Methods: We analyzed data from 3,288 Non-Hispanic (NH) Black and White Chronic Renal Insufficiency Cohort (CRIC) study participants. CRIC is a nationwide, ongoing longitudinal study of men and women aged 21—74 years with CKD. We collected baseline data on insurance type, income, marital and employment status, and education from each participant. We defined incident PAD as incident amputation, bypass, angioplasty, or surgical revascularization or ankle-brachial index (ABI) ≤ 0.9. Overall and race-stratified Cox proportional hazards models estimated the association between SDOH and incident PAD, adjusting for demographics, kidney function, smoking, and other comorbidities.

Results: Participants were on average 58.5 years old; 54% were men, 50% were NH-White and 50% were NH-Black. There were 567 incident cases of PAD over an average of 10.8 years of follow-up. Participants with government/self-pay insurance had a 1.49-fold increased risk of PAD (95% CI: 1.26—1.77), and low income was associated with a 1.42-fold increased risk (95% CI: 1.23-1.64) compared to reference groups. Among Non-Hispanic Black participants, unemployment (HR=1.30, 95% CI: 1.09–1.57) and low income (HR=1.44, 95% CI: 1.14–1.81) were associated increased risk of PAD incidence, while in Non-Hispanic White, government/self-pay insurance (HR=2.13, 95% CI: 1.64–2.77) and low income (HR=1.31, 95% CI: 1.09–1.58) were associated increased risk of PAD compared to the reference groups.

Conclusion: Government/self-pay insurance, unemployment, and income of ≤ $50,000 were significantly associated with incident PAD. In NH-Black participants unemployment and low income were significantly associated with PAD, and in NH-White participants, government/self-pay insurance, income of ≤ $50,000, being unmarried, unemployment were associated with the increased risk of PAD. These findings emphasize the importance of addressing SDOH in the prevention of PAD among individuals with CKD.