Vital Signs: Decrease in Incidence of Diabetes-Related End-Stage Renal Disease among American Indians/Alaska Natives - United States, 1996-2013.
Vital Signs: Decrease in Incidence of Diabetes-Related End-Stage Renal Disease among American Indians/Alaska Natives - United States, 1996-2013.
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DOI：
10.15585/mmwr.mm6601e1
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发表时间：
2017-01-13
期刊：
影响因子：
--
通讯作者：
Espey D
中科院分区：
文献类型：
--
作者：
Bullock A;Burrows NR;Narva AS;Sheff K;Hora I;Lekiachvili A;Cain H;Espey D
美国印第安人和阿拉斯加原住民(AI/AN)是美国所有种族/民族中糖尿病患病率最高的群体。在AI/AN中，糖尿病占终末期肾病(ESRD)新病例的69%，ESRD被定义为通过透析或移植治疗的肾衰竭。1982-1996年间，AI/AN中的糖尿病相关终末期疾病(ESRD-D)大幅增加，与其他种族/民族相比不成比例。来自美国肾脏数据系统、印度医疗服务机构、全国健康访谈调查和美国人口普查的数据被用来计算1996年至2013年期间18岁≥美国成年人以及2006年至2013年糖尿病人口中按种族/民族划分的ESRD-D发病率。税率是根据2000年美国标准人口进行年龄调整的。分析来自糖尿病护理和结果审计的IHS临床数据，以确定AI/AN中的糖尿病管理措施。在人工智能/成人中，年龄调整后的ESRD-D发病率每10万人下降54%，从1996年的57.3降至2013年的26.5。尽管在此期间，其他种族/族裔群体的成年人的比率也有所下降，但AI/AN的下降幅度最大。在患有糖尿病的AI/AN中，ESRD-D的发病率在2006-2013年间下降，到2013年，与白人的发病率相同。与ESRD-D风险因素的评估和治疗相关的措施也显示，在此期间，AI/AN患者的改善程度也高于普通人群。尽管AI/AN之间的健康和社会经济差异得到了很好的证明，但自1996年以来，这一人群中ESRD-D的发病率大幅下降。这一下降是在1980年代中期国际卫生系统对糖尿病实施公共卫生和人口管理办法并改善临床护理之后出现的。这些方法可能是其他医疗保健系统中糖尿病管理的有用模式，特别是那些服务于高危人群的系统。
American Indians and Alaska Natives (AI/AN) have the highest diabetes prevalence among any racial/ethnic group in the United States. Among AI/AN, diabetes accounts for 69% of new cases of end-stage renal disease (ESRD), defined as kidney failure treated with dialysis or transplantation. During 1982–1996, diabetes-related ESRD (ESRD-D) in AI/AN increased substantially and disproportionately compared with other racial/ethnic groups. Data from the U.S. Renal Data System, the Indian Health Service (IHS), the National Health Interview Survey, and the U.S. Census were used to calculate ESRD-D incidence rates by race/ethnicity among U.S. adults aged ≥18 years during 1996–2013 and in the diabetic population during 2006–2013. Rates were age-adjusted based on the 2000 U.S. standard population. IHS clinical data from the Diabetes Cares and Outcomes Audit were analyzed for diabetes management measures in AI/AN. Among AI/AN adults, age-adjusted ESRD-D rates per 100,000 population decreased 54%, from 57.3 in 1996 to 26.5 in 2013. Although rates for adults in other racial/ethnic groups also decreased during this period, AI/AN had the steepest decline. Among AI/AN with diabetes, ESRD-D incidence decreased during 2006–2013 and, by 2013, was the same as that for whites. Measures related to the assessment and treatment of ESRD-D risk factors also showed more improvement during this period in AI/AN than in the general population. Despite well-documented health and socioeconomic disparities among AI/AN, ESRD-D incidence rates among this population have decreased substantially since 1996. This decline followed implementation by the IHS of public health and population management approaches to diabetes accompanied by improvements in clinical care beginning in the mid-1980s. These approaches might be a useful model for diabetes management in other health care systems, especially those serving populations at high risk.
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