Survival Disparity of African American Versus Non-African American Patients With ESRD Due to SLE
Survival Disparity of African American Versus Non-African American Patients With ESRD Due to SLE
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DOI：
10.1053/j.ajkd.2015.04.011
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发表时间：
2015-10-01
影响因子：
13.2
通讯作者：
Abbott, Kevin C.
中科院分区：
文献类型：
--
作者：
Nee, Robert;Martinez-Osorio, Jorge;Abbott, Kevin C.
背景：最近的一项研究显示，与白人相比，非洲裔美国人因狼疮肾炎（LN）而患终末期肾病（ESRD）的死亡风险增加。我们评估了年龄分层、社会经济因素和肾移植对非洲裔美国人与非非洲裔美国人ln引起的ESRD患者生存差异的影响，并与其他原因进行了比较。研究设计：回顾性队列研究。环境和参与者：使用美国肾脏数据系统数据库，我们在1995年1月1日至2006年12月31日期间开始维持透析治疗的1132202例患者中确定了12352例ln引起的ESRD患者，并随访至2010年12月31日。预测因素：基线人口统计和合并症，西班牙裔，社会经济因素（就业状况，医疗保险/医疗补助保险，以及2000年美国人口普查中基于邮政编码的地区家庭收入中位数），肾移植作为一个时间相关变量。结果：全因死亡率。测量方法：多变量Cox和竞争风险回归。结果：ln引起的ESRD和其他原因的ESRD队列的平均随访时间分别为6.24 +/- 4.20 （SD）和4.06 +/- 3.61年。研究期间，ln所致ESRD死亡6106例（49.43%），其他原因ESRD死亡853762例（76.24%）（P < 0.001）。ln引起的ESRD患者明显更年轻（平均年龄39.92岁），女性（81.65%）和非裔美国人（48.13%）的发生率高于其他原因的ESRD。在完全校正的多变量Cox回归模型中，非洲裔美国人（与非非洲裔美国人相比）ln引起的ESRD患者在18 - 30岁（校正HR， 1.43; 95% CI, 1.24-1.65）和31 - 40岁（校正HR， 1.17; 95% CI, 1.02-1.34）的死亡风险显著增加。在其他原因的ESRD患者中，非裔美国人在18 - 30岁时的风险显著增加（校正HR， 1.17; 95% CI, 1.11-1.22）。局限性：我们使用基于邮政编码的家庭收入中位数作为患者收入的替代。残留的社会经济混杂因素可能存在。结论：与非非洲裔美国人相比，非非洲裔美国人在18至40岁期间因ln引起的ESRD死亡的风险显著增加，种族差异风险比一般ESRD人群长10年。考虑到地区水平的家庭收入中位数和移植显著降低了非洲裔美国人与非非洲裔美国人ln引起的ESRD患者死亡率的差异。Elsevier Inc.出版。
Background: A recent study showed an increased risk of death in African Americans compared with whites with end-stage renal disease (ESRD) due to lupus nephritis (LN). We assessed the impact of age stratification, socioeconomic factors, and kidney transplantation on the disparity in patient survival among African American versus non-African American patients with LN-caused ESRD, compared with other causes.Study Design: Retrospective cohort study.Setting & Participants: Using the US Renal Data System database, we identified 12,352 patients with LN-caused ESRD among 1,132,202 patients who initiated maintenance dialysis therapy from January 1, 1995, through December 31, 2006, and were followed up until December 31, 2010.Predictors: Baseline demographics and comorbid conditions, Hispanic ethnicity, socioeconomic factors (employment status, Medicare/Medicaid insurance, and area-level median household income based on zip code as obtained from the 2000 US census), and kidney transplantation as a time-dependent variable.Outcome: All-cause mortality.Measurements: Multivariable Cox and competing-risk regressions.Results: Mean duration of follow-up in the LN-caused ESRD and other-cause ESRD cohorts were 6.24 +/- 4.20 (SD) and 4.06 +/- 3.61 years, respectively. 6,106 patients with LN-caused ESRD (49.43%) and 853,762 patients with other-cause ESRD (76.24%) died during the study period (P < 0.001). Patients with LN-caused ESRD were significantly younger (mean age, 39.92 years) and more likely women (81.65%) and African American (48.13%) than those with other-cause ESRD. In the fully adjusted multivariable Cox regression model, African American (vs non-African American) patients with LN-caused ESRD had significantly increased risk of death at age 18 to 30 years (adjusted HR, 1.43; 95% CI, 1.24-1.65) and at age 31 to 40 years (adjusted HR, 1.17; 95% CI, 1.02-1.34). Among patients with other-cause ESRD, African Americans were at significantly increased risk at age 18 to 30 years (adjusted HR, 1.17; 95% CI, 1.11-1.22).Limitations: We used zip code-based median household income as a surrogate for patient income. Residual socioeconomic confounders may exist.Conclusions: African Americans are at significantly increased risk of death compared with non-African Americans with LN-caused ESRD at age 18 to 40 years, a racial disparity risk that is 10 years longer than that in the general ESRD population. Accounting for area-level median household income and transplantation significantly attenuated the disparity in mortality of African American versus non-African American patients with LN-caused ESRD. Published by Elsevier Inc.