Incidence of end-stage renal disease and death among insured African Americans with chronic kidney disease
Incidence of end-stage renal disease and death among insured African Americans with chronic kidney disease
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DOI：
10.1038/ki.2009.209
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发表时间：
2009-09-01
影响因子：
19.6
通讯作者：
Crooks, Peter W.
中科院分区：
文献类型：
--
作者：
Derose, Stephen F.;Rutkowski, Mark P.;Crooks, Peter W.
在美国，非裔美国人的终末期肾病（ESRD）发病率最高。为了了解这种差异的根源，我们检查了预付费综合卫生系统的数据，以进行这项回顾性队列研究，对象是在 9 年期间进行过一次或多次血清肌酐测试的成员。该队列包括 182,959 名患有 3 期或 4 期慢性肾病的成年人（8% 是黑人），根据他们估计的肾小球滤过率 (eGFR) 进行计算。使用竞争风险方法来确定 ESRD 的发生率和 ESRD 之前的死亡。在所有随访时间和任何 eGFR 记录中，黑人 ESRD 的累积发病率均显着更高。与非黑人相比，黑人 ESRD 和 ESRD 前死亡的年龄和性别调整风险比分别为 1.83 和 1.15。研究发现，70 岁及以上 eGFR 4 期黑人的无 ESRD 生存率有所提高。与非黑人相比，黑人的 ESRD 或死亡综合结果的风险比为 1.31。尽管拥有同等的健康保险福利，但患有慢性肾病的黑人患终末期肾病和终末期肾病之前死亡的风险增加。与非黑人相比，患有慢性肾病的黑人进入终末期肾病 (ESRD) 的可能性是在终末期肾病 (ESRD) 之前死亡的可能性的两倍。
African Americans have the highest incidence of end-stage renal disease (ESRD) in the United States. To understand the basis of this disparity, we examined data from a prepaid, integrated health system for this retrospective cohort study of members who had one or more serum creatinine tests performed over a 9-year period. The cohort included 182,959 adults (8% black) with stage 3 or 4 chronic kidney disease based on their estimated glomerular filtration rate (eGFR). Competing-risk methods were used to determine the incidence of ESRD and death prior to ESRD. At all follow-up times and from any entry eGFR, the cumulative incidence of ESRD was significantly greater in blacks. The age and gender-adjusted hazard ratios for ESRD and death prior to ESRD in blacks compared to non-blacks were 1.83 and 1.15, respectively. Increased survival free of ESRD was found in blacks 70 years and older with eGFR stage 4. The hazard ratio for the combined outcomes of ESRD or death was 1.31 in blacks as compared to non-blacks. Despite equivalent health insurance benefits, blacks with chronic kidney disease were at increased risk for ESRD and death prior to ESRD. Compared to non-blacks, blacks with chronic kidney disease were twice as likely to enter into ESRD as to die prior to ESRD.