Economic Development and Chronic Kidney Disease Prevalence: Evidence of Nonlinearity from a Global Panel, 1995–2023

Abstract

Chronic kidney disease (CKD) affects millions worldwide, with substantial cross-country disparities in prevalence and sociodemographic development. This study examines whether the association between CKD prevalence and economic development is nonlinear and consistent with an inverted U-shaped pattern. An unbalanced country-level panel for 1995–2023 combines age-standardized CKD prevalence estimates from the Global Burden of Disease Study 2023 with economic and health indicators from the World Development Indicators. Economic development is measured by GDP per capita at purchasing power parity in constant 2021 international dollars. The analysis uses two-way fixed effects, semiparametric estimation, and supplementary two-step System GMM. Fixed-effects estimates generally support an inverted U-shaped relationship after controlling for country and year fixed effects and environmental, metabolic, and health-system covariates. High systolic blood pressure exposure is positively and significantly associated with CKD prevalence. In the preferred broad-control model, the implied turning point is approximately 34,685 international dollars, although sensitive to specification and sample composition. Semiparametric estimates show a similar pattern with a flat peak and gradual decline at higher incomes. System GMM indicates substantial persistence and specification-dependent evidence of nonlinearity. Overall, economic development alone may be insufficient to reduce CKD prevalence, highlighting the importance of health investment and risk-factor management. JEL classification numbers: I15, C23, O11. Keywords: Chronic Kidney Disease, Economic Development, Nonlinearity, Two-Way Fixed Effects, System GMM.