Disparities in Mortality of Hispanic Patients with Cystic Fibrosis in the United States A National and Regional Cohort Study
Disparities in Mortality of Hispanic Patients with Cystic Fibrosis in the United States A National and Regional Cohort Study
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DOI：
10.1164/rccm.201711-2357oc
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发表时间：
2018-10-15
影响因子：
24.7
通讯作者：
Jain, Raksha
中科院分区：
文献类型：
--
作者：
Rho, Jason;Ahn, Chul;Jain, Raksha
理论基础：西班牙裔起源的囊性纤维化(CF)患者是增长中的最大少数，占美国囊性纤维化患者的8.5%。目标：我们的目的是确定在CF人群中拉美裔种族是否与更差的预后相关，以及是否存在任何地理差异。方法：使用美国囊性纤维化基金会患者登记数据，使用Kaplan-Meier和Cox回归分析，对拉美裔和非拉美裔之间的生存率进行了回顾性队列分析。根据美国人口普查局的数据，受试者的居住地被划分为地理区域：东北部、中西部、西部和南部。测量和主要结果：研究包括总共29,637名患者；2,493名自称是西班牙裔的患者。拉美裔总体生存概率较低，平均死亡年龄为22.4±69.9岁，非拉美裔为28.16±10.0岁(P<；0.0001)。多变量COX比例风险模型显示，在调整了年龄、性别、基因突变、细菌培养、肺功能、体重指数、使用CF呼吸疗法、低社会经济地位、使用胰酶和CF相关糖尿病等协变量后，西班牙裔CF患者的死亡率是非拉美裔患者的1.27倍(95%可信区间，1.05-1.53)。按地区分析，中西部、东北部和西部的拉美裔患者的中位生存期比非西班牙裔短，南部地区没有表现出这一点。结论：西班牙裔患者的死亡率高于非西班牙裔患者。这种模式在中西部、东北部和西部出现，但在南部没有出现。
Rationale: Patients of Hispanic origin with cystic fibrosis (CF) are the largest growing minority, representing 8.5% of patients with CF in the United States. No national survival analysis of this group has ever been undertaken.Objectives: We aimed to determine whether Hispanic ethnicity within the CF population is associated with worse outcomes and whether any geographic differences exist.Methods: Using U.S. Cystic Fibrosis Foundation Patient Registry data from 2010 to 2014, we performed a retrospective cohort analysis comparing survival rates between Hispanics and non-Hispanics using Kaplan-Meier and Cox regression analysis. A subject's residence was categorized into geographic regions based on U.S. Census Bureau data: Northeast, Midwest, West, and South.Measurements and Main Results: A total of 29,637 patients were included in the study; 2,493 identified themselves as Hispanic. Hispanics had a lower survival probability overall, with a mean age of death of 22.4 +/- 69.9 years compared with non-Hispanics of 28.16 +/- 10.0 years (P < 0.0001). Multivariate Cox proportional hazards modeling revealed that Hispanic patients with CF had a 1.27 times higher rate of death compared with non-Hispanics (95% confidence interval, 1.05-1.53) after adjusting for covariates including age, sex, genetic mutations, bacterial cultures, lung function, body mass index, use of CF respiratory therapies, low socioeconomic status, pancreatic enzyme use, and CF-related diabetes. When analyzed by region, Hispanics in the Midwest, Northeast, and West had shorter median survivals compared with non-Hispanics, which was not demonstrated in the South.Conclusions: Patients with CF of Hispanic origin have a higher mortality rate than non-Hispanic patients with CF. This pattern was seen in the Midwest, Northeast, and West but not in the South.