A community-based study of explanatory factors for the excess risk for early renal function decline in blacks vs whites with diabetes - The atherosclerosis risk in communities study
A community-based study of explanatory factors for the excess risk for early renal function decline in blacks vs whites with diabetes - The atherosclerosis risk in communities study
复制标题
DOI：
10.1001/archinte.159.15.1777
复制
发表时间：
1999-08-09
影响因子：
--
通讯作者：
Brancati, FL
中科院分区：
文献类型：
--
作者：
Krop, JS;Coresh, J;Brancati, FL
背景：黑人患糖尿病肾病风险过高的原因尚不明确。
目的：比较黑人和白人成年糖尿病患者早期肾功能下降的发生率，并研究种族差异可能的解释因素。
设计：前瞻性队列研究。
地点：参与社区动脉粥样硬化风险研究的4个美国社区。
参与者：1434名年龄在45至64岁的社区糖尿病成年患者样本。
测量：通过结构化访谈、体格检查结果和实验室检测进行详细的基线评估。
主要结果：早期肾功能下降定义为在3年随访期间血清肌酐至少增加35.4 μmol/L（0.4 mg/dL）。
结果：在3年随访期间，45名黑人（每1000人年28.4例）和25名白人（每1000人年9.6例）出现早期肾功能下降。在对年龄、性别和基线血清肌酐水平进行调整后，黑人发生早期肾功能下降的可能性是白人的3倍多（比值比为3.15；95%置信区间为1.86 - 5.33）。进一步对教育程度、家庭收入、医疗保险、空腹血糖水平、平均收缩压、吸烟史和体力活动水平进行调整后，黑人的相对比值降至1.38（95%置信区间为0.71 - 2.69），相当于过高风险降低了82%。
结论：这些数据表明，黑人发生早期肾功能下降的可能性是白人的3倍，潜在的可改变因素，包括较低的社会经济地位、不理想的健康行为以及对血糖水平和血压的不理想控制，占这种差异的80%以上。
Context: The explanation for the excess risk for diabetic renal disease in blacks is uncertain.Objectives: To compare the incidence of early renal function decline in black and white adults with diabetes and to examine possible explanatory factors for racial differences.Design: Prospective cohort study.Setting: Four US communities participating in the Atherosclerosis Risk in Communities study.Participants: Community-based sample of 1434 diabetic adults aged 45 to 64 years.Measurements: Detailed baseline assessment using structured interview, results of physical examination, and laboratory measurements.Main Outcome: Development of early renal function decline defined by an increase in serum creatinine of at least 35.4 mu mol/L (0.4 mg/dL) during 3 years of follow-up.Results: During 3 years of follow-up, early renal function decline developed in 45 blacks (28.4 per 1000 person-years [PY]) and 25 whites (9.6 per 1000 PY). After adjustment for age, sex, and baseline serum creatinine level, early renal function decline was more than 3 times as likely to develop in blacks than whites (odds ratio, 3.15; 95% confidence interval, 1.86-5.33). Additional adjustment for education, household income, health insurance, fasting glucose level, mean systolic blood pressure, smoking history, and physical activity level reduced the relative odds in blacks to 1.38 (95% confidence interval, 0.71-2.69), corresponding to a 82% reduction in excess risk.Conclusions: These data suggest that early renal function decline is 3 times more likely to develop in blacks than whites and that potentially modifiable factors, including lower socioeconomic status, suboptimal health behaviors, and suboptimal control of glucose level and blood pressure, account for more than 80% of this disparity.