Prognosis in proliferative lupus nephritis: the role of socio-economic status and race/ethnicity
Prognosis in proliferative lupus nephritis: the role of socio-economic status and race/ethnicity
复制标题
DOI：
10.1093/ndt/gfg345
复制
发表时间：
2003-10-01
影响因子：
6.1
通讯作者：
Radhakrishnan, J
中科院分区：
文献类型：
--
作者：
Barr, RG;Seliger, S;Radhakrishnan, J
背景增生性狼疮肾炎（PLN）的研究表明，非洲裔美国人的预后比白人差。然而，没有一项研究同时审查社会经济状况。我们研究了PLN的进展率在三个民族的人口与社会经济地位和种族/ethnicity. Methods。回顾性队列研究进行了个人和基于人口普查的邻里数据。研究了城市三级医疗中心活检证实PLN的并发症患者。主要结果是血清肌酐加倍的时间。在128名PLN患者中，5年时血清肌酐未翻倍的患者百分比为67.0%（4.8%），10年时为58.9%（15.7%）。在双变量分析中，居住在贫困社区与疾病进展呈正相关（P = 0. 05）。非裔美国人和西班牙裔人种/种族（P=0.01）。在调整年龄、性别、肌酐、高血压、环磷酰胺治疗和种族/种族后，居住在贫困社区仍然与疾病进展相关[相对风险（RR）3.5，95%置信区间（CI）1.2-11，P=0.03]。经贫困和保险调整后，非裔美国人种族/民族的RR从3.5降至2.7，在全模型中与疾病进展无统计学相关性（P = 0. 05）。10）。西班牙裔人种/种族的RR从5.5降至3.6，但仍具有统计学意义（P = 0.03）。贫困是PLN发展的一个重要风险因素，与种族/族裔无关。西班牙裔美国人的风险与非洲裔美国人相似或更高。鉴于这些发现，一些非洲裔美国人PLN患者的预后较差可能是由于社会经济因素，而不是生物或遗传因素。
Background. Studies of proliferative lupus nephritis (PLN) suggest that African-Americans have a poorer prognosis than Whites. However, no study has simultaneously examined socio-economic status. We studied rates of progression of PLN among a tri-ethnic population with respect to socio-economic status and race/ethnicity.Methods. A retrospective cohort study was carried out using individual and census-based neighbourhood data. Consecutive patients in urban tertiary care centres with biopsy-proven PLN were studied. The main outcome was time to doubling of serum creatinine.Results. Among 128 patients with PLN, the percentage of patients who did not double their serum creatinine at 5 years was 67.0% ( 4.8%) and at 10 years was 58.9% (15.7%). In bivariate analyses, residence in a poor neighbourhood was positively associated with progression (P = 0. 03), as was African-American and Hispanic race/ethnicity (P=0.01). Residence in a poor neighbourhood remained associated with progression of disease after adjustment for age, sex, creatinine, hypertension, cyclophosphamide treatment and race/ ethnicity [relative risk (RR) 3.5, 95% confidence interval (CI) 1.2-11, P=0.03]. After adjustment for poverty and insurance, the RR for African-American race/ethnicity was reduced from 3.5 to 2.7 and was not statistically associated with progression of disease in the full model (P = 0. 10). A similar reduction in RR from 5.5 to 3.6 was seen for Hispanic race/ethnicity, but this retained statistical significance (P = 0.03).Conclusions. Poverty is an important risk factor for progression of PLN, independent of race/ethnicity. Hispanics have an elevated risk similar to or greater than African-Americans. Given these findings, some of the poorer prognosis of African-American patients with PLN may result from socio-economic rather than biological or genetic factors.