Assessing Differences in Mortality Rates and Risk Factors Between Hispanic and Non-Hispanic Patients With Cystic Fibrosis in California
Assessing Differences in Mortality Rates and Risk Factors Between Hispanic and Non-Hispanic Patients With Cystic Fibrosis in California
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DOI：
10.1378/chest.14-2189
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发表时间：
2016-02-01
期刊：
影响因子：
9.6
通讯作者：
Wise, Paul H.
中科院分区：
文献类型：
--
作者：
Buu, MyMy C.;Sanders, Lee M.;Wise, Paul H.
背景：在过去的30年里，治疗进展延长了囊性纤维化（CF）患者的中位寿命。西班牙裔患者是一个脆弱的亚群，具有较高的患病率的风险因素，更糟糕的健康结果。这些差异对健康结果的影响尚未得到很好的描述。本研究的目的是表征西班牙裔和非西班牙裔CF患者之间的健康结局差异，包括死亡率。方法：本研究回顾性分析了1991年至2010年期间或之后诊断为CF的加州居民的CF基金会患者登记数据。种族是自我报告的。主要结局为死亡率。根据考克斯回归模型估计风险比，按性别分层，并根据社会经济状况、临床危险因素和诊断年份进行调整。85例死亡，总死亡率为4.9%。西班牙裔患者的未校正死亡率高于非西班牙裔患者（9.1% vs 3.3%，P <0.0001）。与非西班牙裔患者相比，西班牙裔患者在诊断后18年的生存率较低（75.9% vs 91.5%，P <0.0001）。经社会经济地位和临床危险因素调整后，西班牙裔患者的死亡率高于非西班牙裔患者（风险比，2.81; 95%CI，1.70-4.63）。结论：西班牙裔CF患者的死亡率高于非西班牙裔患者，即使在调整社会经济地位和临床严重程度后。进一步研究肺功能测量差异的机制将有助于为干预提供信息，并改善所有CF患者的健康状况。
BACKGROUND: Over the past 30 years, therapeutic advances have extended the median lifespan of patients with cystic fibrosis (CF). Hispanic patients are a vulnerable subpopulation with a high prevalence of risk factors for worse health outcomes. The consequences of these differences on health outcomes have not been well described. The objective of this study was to characterize the difference in health outcomes, including mortality rate, between Hispanic and non-Hispanic patients with CF.METHODS: This study is a retrospective analysis of CF Foundation Patient Registry data of California residents with CF, diagnosed during or after 1991, from 1991 to 2010. Ethnicity was self-reported. The primary outcome was mortality. Hazard ratios were estimated from a Cox regression model, stratified by sex, and adjusted for socioeconomic status, clinical risk factors, and year of diagnosis.RESULTS: Of 1,719 patients, 485 (28.2%) self-identified as Hispanic. Eighty-five deaths occurred, with an overall mortality rate of 4.9%. The unadjusted mortality rate was higher among Hispanic patients than among non-Hispanic patients (9.1% vs 3.3%, P < .0001). Compared with non-Hispanic patients, Hispanic patients had a lower survival rate 18 years after diagnosis (75.9% vs 91.5%, P < .0001). Adjusted for socioeconomic status and clinical risk factors, Hispanic patients had an increased rate of death compared with non-Hispanic patients (hazard ratio, 2.81; 95% CI, 1.70-4.63).CONCLUSIONS: Hispanic patients with CF have a higher mortality rate than do non-Hispanic patients, even after adjusting for socioeconomic status and clinical severity. Further investigation into the mechanism for the measured difference in lung function will help inform interventions and improve the health of all patients with CF.