Racial Disparities in Renal Outcomes Over Time Among Hospitalized Children With Systemic Lupus Erythematosus.
Racial Disparities in Renal Outcomes Over Time Among Hospitalized Children With Systemic Lupus Erythematosus.
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DOI：
10.1002/art.42127
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发表时间：
2022-08
影响因子：
13.3
通讯作者：
Son, Mary Beth F.
中科院分区：
文献类型：
--
作者：
Chang, Joyce C.;Sears, Cora;Torres, Veronica;Son, Mary Beth F.
在儿童期系统性红斑狼疮（SLE）患者中，种族和少数民族人群与肾脏疾病相关的发病率较高。我们评估了14年以上SLE住院儿童肾脏预后的时间趋势和种族差异。我们在儿科健康信息系统®住院患者数据库（2006-2019）中确定了出院诊断为SLE的≤21岁患者。肾脏不良结局包括终末期肾病（ESRD）、透析或移植，作为复合终点和单独分析。我们估计了任何住院时发生不良肾脏结局的几率，或首次发生不良肾脏结局的几率，并根据日历周期、患者特征和医院聚类进行了调整。我们测试了种族差异是否因日历周期而异。7，434例SLE患者中有20，893例入院，其中黑人、西班牙裔白色人、西班牙裔其他人和亚洲人分别占32%、16%、12%和8%。随着时间的推移，肾功能不良的入院比例下降（p<0.01）。在任何入院时，黑人儿童的不良肾脏结局风险仍然最高（OR 2.5，95% CI [1.8-3.5] vs.非西班牙裔白色）。黑人和亚裔儿童发生肾脏不良结局的风险仍然较高，黑人儿童受ESRD（OR 1.6 [1.2-2.1]）和亚裔儿童受透析（OR 1.7 [1.1-2.7]）驱动。相对差距并没有随着时间的推移而发生重大变化。在所有种族和民族组中，SLE儿童的终末期肾病和透析随着时间的推移而显著减少。种族差异没有相应减少，这突出表明需要采取有针对性的干预措施，在高危群体中实现更大的治疗获益。
Racial and ethnic minority groups have excess morbidity related to renal disease in pediatric-onset systemic lupus erythematosus (SLE). We evaluated temporal trends in renal outcomes and racial disparities among hospitalized children with SLE over 14 years. We identified patients ≤21 years-old with discharge diagnoses of SLE in the Pediatric Health Information System® inpatient database (2006-2019). Adverse renal outcomes included end-stage renal disease (ESRD), dialysis, or transplant, analyzed as a composite and separately. We estimated the odds of adverse renal outcomes at any hospitalization, or the first occurrence of an adverse renal outcome, adjusted for calendar period, patient characteristics, and clustering by hospital. We tested whether racial disparities differed by calendar period. There were 20,893 admissions for 7,434 SLE patients, of which 32%, 16%, 12% and 8% were Black, Hispanic White, Hispanic Other and Asian, respectively. Proportions of admissions with adverse renal outcomes decreased over time (p<0.01). Black children remained at highest risk of adverse renal outcomes at any admission (OR 2.5, 95% CI [1.8-3.5] vs. non-Hispanic White). Black and Asian children remained at higher risk of incident adverse renal outcomes, driven by ESRD among Black children (OR 1.6 [1.2-2.1]) and dialysis among Asians (OR 1.7 [1.1-2.7]). Relative disparities did not change significantly over time. Significant reductions in ESRD and dialysis occurred over time for children with SLE across all racial and ethnic groups. The lack of corresponding reductions in racial disparities highlights the need for targeted interventions to achieve greater treatment benefit among higher risk groups.
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期刊：
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影响因子：
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