Chronic kidney disease mortality trends in selected Central America countries, 1997-2013: clues to an epidemic of chronic interstitial nephritis of agricultural communities
Chronic kidney disease mortality trends in selected Central America countries, 1997-2013: clues to an epidemic of chronic interstitial nephritis of agricultural communities
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DOI：
10.1136/jech-2017-210023
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发表时间：
2018-04-01
影响因子：
6.3
通讯作者：
Hoy, Wendy E.
中科院分区：
文献类型：
--
作者：
Ordunez, Pedro;Nieto, F. Javier;Hoy, Wendy E.
背景 在中美洲，农业社区慢性间质性肾炎 (CINAC) 已达到流行程度。一些农业社区出现了聚集性病例。其病因学仍不确定，其关键触发因素存在争议，其中包括热应激脱水机制和农药有毒暴露。 方法本研究根据《国际疾病和相关健康问题统计分类-第10版》，1997年至2013年在四个选定的中美洲国家中分析了慢性肾病代码N18（CKD-N18）的死亡模式和趋势，作为死亡的代理和根本原因。此外，我们使用指数回归来回顾性模拟该流行病可能的发病和先前的轨迹。 结果 1997 年至 2013 年间，CKD-N18 死亡人数为 47 885 人（31% 为女性），其中 19 533 人发生在 60 岁以下（26% 为女性）。男孩和女孩的死亡率早在 10-14 岁时就开始出现。萨尔瓦多和尼加拉瓜的死亡率比参考国家高 9 倍至 12 倍，受影响最严重。统计模型表明，该流行病大约在 20 世纪 70 年代中期开始，恰逢农业生产方式的重要变化。 结论 这项研究提供了迄今为止发表的对该流行病最全面的死亡率分析，并证实了 CKD-N18 死亡率过高及其与 CINAC 流行的关系。妇女、儿童和青少年的总体趋势和死亡率模式表明，热应激脱水假说无法完全解释这种流行病，其他环境因素（更可能是农业实践和农用化学品）可能与此有关。
Background In Central America, chronic interstitial nephritis of agricultural communities (CINAC) has reached epidemic proportions. Clusters of cases have been described in several farming communities. Its aetiology remains uncertain and a controversy exists on its key triggers, among them the heat stress-dehydration mechanism and the toxic exposure to agrochemicals.Methods This study analysed the mortality pattern and trend of chronic kidney disease code N18 (CKD-N18) according to the International Statistical Classification of Diseases and Related Health Problems-10th Revision, the proxy and the underlying cause of death, in four selected Central American countries from 1997 to 2013. In addition, we used exponential regression to retrospectively model the likely onset and prior trajectory of the epidemic.Results Between 1997 and 2013, CKD-N18 mortality accounting 47 885 deaths (31% were female), 19 533 of which occurred below 60years of age (26% female). The excess of mortality starts as early as 10-14years of age for both boys and girls. El Salvador and Nicaragua, with mortality rates between 9-fold and 12-fold higher than reference countries, were the most affected. Statistical modelling suggests that the epidemic commenced around the mid-1970s, coinciding with important changes in modes of agricultural production.Conclusions This study provides the most comprehensive mortality analysis of this epidemic published to date and confirms an excess of CKD-N18 mortality and its relation with the epidemic of CINAC. The overall trends and the mortality pattern among women, children and adolescents suggest that the heat stress-dehydration hypothesis cannot fully explain this epidemic and that other environmental factors, more likely agricultural practices and agrochemicals, may be causally involved.