Association of Race With Mortality and Cardiovascular Events in a Large Cohort of US Veterans
Association of Race With Mortality and Cardiovascular Events in a Large Cohort of US Veterans
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DOI：
10.1161/circulationaha.114.015124
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发表时间：
2015-10-20
期刊：
影响因子：
37.8
通讯作者：
Kalantar-Zadeh, Kamyar
中科院分区：
文献类型：
--
作者：
Kovesdy, Csaba P.;Norris, Keith C.;Kalantar-Zadeh, Kamyar
背景-在一般人群中，黑人的死亡率高于他们的白色同龄人，部分原因是他们的社会经济地位较低，获得护理的机会较少，可能还有内在的生物因素。肾病患者是一个明显的例外，其中黑人的死亡率较低。目前尚不清楚在无肾脏疾病但获得同等或类似医疗保健的患者中是否存在影响结局的类似差异。方法和结果-我们使用多变量校正的考克斯模型比较了一个全国性队列中的547441名黑人和2525525名白色患者的全因死亡率、冠心病事件和缺血性卒中事件，基线估计肾小球滤过率>= 60 mL。min- 1。1.73 m- 2接受美国退伍军人健康管理局的护理。在平行分析中，我们比较了1999年至2004年国家健康和营养调查（NHANES）中黑人与白色个体的结果。在对退伍军人进行多变量调整后，黑人种族的全因死亡率降低了24（校正风险比，0.76; 95%置信区间，0.75- 0.77; P< 0.001）和冠心病发病率降低37%（校正的危险比，0.63; 95%置信区间，0.62- 0.65; P< 0.001），但缺血性卒中的发生率相似（校正的危险比，0.99; 95%置信区间，0.97- 1.01; P= 0.3）。估计肾小球滤过率>= 60 mL的个体中，黑人与高42%的校正死亡率相关。min- 1。1.73 NHANES中的m- 2（校正的风险比，1.42; 95%置信区间，1.09- 1.87）。结论--肾小球滤过率估计值正常且平等获得医疗保健的黑人退伍军人的全因死亡率和冠心病发病率较低，缺血性中风发病率相似。这些关联与美国一般人群中黑人个体经历的较高死亡率形成对比。（循环。2015; 132：1538- 1548. DOI：10.1161/ARATIONAHA。114.015124.）
Background- In the general population, blacks experience higher mortality than their white peers, attributed in part to their lower socioeconomic status, reduced access to care, and possibly intrinsic biological factors. Patients with kidney disease are a notable exception, among whom blacks experience lower mortality. It is unclear if similar differences affecting outcomes exist in patients with no kidney disease but with equal or similar access to health care. Methods and Results- We compared all- cause mortality, incident coronary heart disease, and incident ischemic stroke using multivariable- adjusted Cox models in a nationwide cohort of 547 441 black and 2 525 525 white patients with baseline estimated glomerular filtration rate >= 60 mL . min- 1 . 1.73 m- 2 receiving care from the US Veterans Health Administration. In parallel analyses, we compared outcomes in black versus white individuals in the National Health and Nutrition Examination Survey ( NHANES) 1999 to 2004. After multivariable adjustments in veterans, black race was associated with 24% lower all- cause mortality ( adjusted hazard ratio, 0.76; 95% confidence interval, 0.75- 0.77; P< 0.001) and 37% lower incidence of coronary heart disease ( adjusted hazard ratio, 0.63; 95% confidence interval, 0.62- 0.65; P< 0.001) but a similar incidence of ischemic stroke ( adjusted hazard ratio, 0.99; 95% confidence interval, 0.97- 1.01; P= 0.3). Black race was associated with a 42% higher adjusted mortality among individuals with estimated glomerular filtration rate >= 60 mL . min- 1 . 1.73 m- 2 in NHANES ( adjusted hazard ratio, 1.42; 95% confidence interval, 1.09- 1.87). Conclusions- Black veterans with normal estimated glomerular filtration rate and equal access to healthcare have lower all- cause mortality and incidence of coronary heart disease and a similar incidence of ischemic stroke. These associations are in contrast to the higher mortality experienced by black individuals in the general US population. ( Circulation. 2015; 132: 1538- 1548. DOI: 10.1161/ CIRCULATIONAHA. 114.015124.)