Differential survival selections and care-related determinants among African Americans and Hispanics versus whites with chronic kidney disease

非裔美国人和西班牙裔与患有慢性肾病的白人之间的差异生存选择和护理相关决定因素

• 批准号: 10063514
• 负责人: Guofen Yan
• 金额: $ 35.11万
• 依托单位: UNIVERSITY OF VIRGINIA
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-12-05 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10063514
• 关键词: Address; Affect; African American; Area; Caring; Cessation of life; Characteristics; Chronic Kidney Failure; Clinical; Development; Dialysis procedure; Disadvantaged; Disease; Disease Outcome; End stage renal failure; Ethnic group; Event; Event History Analysis; Fostering; High Prevalence; Hispanics; Incidence; Knowledge; Medicare; Methodology; Minority; Minority Groups; Modeling; National Institute of Diabetes and Digestive and Kidney Diseases; Not Hispanic or Latino; Outcome; Patients; Population; Process; Quality of Care; Records; Research; Risk; Risk Factors; Role; Source; Strategic Planning; Subgroup; Survival Rate; Techniques; Testing; Time; Translating; Transplantation; Veterans; Work; advanced disease; clinical care; cohort; comorbidity; comparative effectiveness analysis; data structure; demographics; ethnic difference; follow-up; frailty; grasp; high risk; improved; improved outcome; innovation; mortality; mortality risk; novel; racial and ethnic; racial and ethnic disparities; simulation

Project Summary This proposal represents our continuing efforts to contribute to NIDDK's Strategic Plan to eliminate racial and ethnic disparities in chronic kidney disease (CKD), including end-stage renal disease (ESRD; stage 5 CKD). Despite extensive research over the last two decades, critical knowledge gaps persist. First, African Americans (AAs) and Hispanics continue to have 2-3 times higher incidence of ESRD than non-Hispanic whites (whites), but paradoxically have much better survival than whites after reaching ESRD and undergoing dialysis. Speculation is that this apparent survival advantage is related to survival disadvantage and inadequate care for AAs and Hispanics during the pre-ESRD period, but confirming this has been hampered by methodological challenges. Second, we still do not understand how differences in mortality between minorities and whites evolve over time as the disease advances. And third, we do not fully grasp how processes of care, which are potentially modifiable and vital to improving outcomes, affect survival selections among minorities (vs. whites). To close these longstanding knowledge gaps, we propose to conduct the first event-history analysis of national incident CKD populations to examine in-depth racial/ethnic disparities in outcomes and processes of care over the full course of CKD. Our central hypothesis is that differences in mortality between minorities (AAs and Hispanics) and whites are time-dependent over the course of CKD, and that differences in ESRD are related to the differences in pre-ESRD, which result from differential survival-selection processes between the groups. The analyses proposed under our three Specific Aims will test this and other specific hypotheses and examine a range of factors for the differential survival selections, particularly the processes of care. Aim 1 will yield a detailed characterization of how racial/ethnic differences in mortality evolve over the full course of CKD. Aim 2 will examine the effect of processes of care on differential survival selections among racial/ethnic groups, which drives the time-dependent changes found in Aim 1. Aim 3 will assess the role of unexplained risks in these differential survival-selection processes. In addition to our novel hypotheses and innovative analytic approaches, this study will foster methodological advances in CKD research, which include the use of 1) two national incident CKD cohorts with >15 years of follow-up that connect the pre-ESRD and ESRD periods—the national veteran CKD population (>1.3 million) for primary analyses, and the Medicare CKD population (>790,000) for further understanding of processes of care across the nation; and 2) advanced statistical techniques, including time-dependent multi-state survival models and frailty models. This study will offer novel understanding of why differential survival rates among AAs and Hispanics vs. whites exist and how they can be addressed. Our results for real-world processes of care among AAs and Hispanics can be directly translated into actionable initiatives to enhance care for minority CKD patients. Building on our team's outstanding record, we anticipate that our efforts will continue to be novel, productive and highly impactful. .

项目摘要 这项提议代表着我们继续努力为NIDDK消除种族和文化歧视的战略计划做出贡献 慢性肾脏疾病(CKD)的种族差异，包括终末期肾病(ESRD；阶段5 CKD)。 尽管在过去20年里进行了广泛的研究，但关键的知识差距依然存在。首先，非裔美国人 AAS和西班牙裔美国人的ESRD发病率仍然是非西班牙裔白人的2-3倍， 但矛盾的是，在到达ESRD并接受透析后，他们的存活率比白人好得多。 据推测，这种明显的生存优势与生存劣势和对 AAS和西班牙裔在ESRD之前的时期，但确认这一点受到方法学的阻碍 挑战。第二，我们仍然不理解少数族裔和白人之间的死亡率差异 随着疾病的发展，会随时间而演变。第三，我们没有完全理解护理的过程，这是 可能是可修改的，对改善结果至关重要，影响少数族裔(与白人)之间的生存选择。 为了弥合这些长期存在的知识差距，我们建议进行第一次事件历史分析 国家突发事件CKD人群审查结果和进程中的深入种族/族裔差异 全程护理慢性肾脏病。我们的中心假设是少数族裔(AA)之间的死亡率差异 和西班牙裔)和白人在CKD的过程中是时间依赖的，ESRD的差异是 与ESRD前的差异有关，这是由于不同的生存选择过程 组。在我们的三个具体目标下提出的分析将检验这一假设和其他具体假设 检查不同生存选择的一系列因素，特别是护理过程。目标1将 对慢性肾脏病整个病程中死亡率的种族/民族差异如何演变进行了详细的描述。 目标2将研究护理过程对种族/民族之间不同生存选择的影响 目标1中发现的与时间相关的变化。目标3将评估未解释的 这些不同的生存选择过程中的风险。除了我们新颖的假设和创新 分析方法，这项研究将促进CKD研究的方法学进步，包括使用 1)两个国家事件CKD队列，具有15年的跟踪调查，将ESRD前和ESRD联系起来 期间-用于初步分析的全国退伍军人CKD人口(&gt；130万)，以及Medicare CKD 人口(&gt；790,000)，以进一步了解全国各地的护理过程；以及2)高级 统计技术，包括时间依赖的多状态生存模型和脆弱性模型。这项研究将 提供新的理解，解释为什么AA和西班牙裔与白人之间存活率存在差异，以及如何 这些问题是可以解决的。我们对再生障碍性贫血和西班牙裔美国人的真实护理过程的结果可以直接 转化为可操作的举措，以加强对少数族裔慢性肾脏病患者的护理。在我们团队的基础上 我们期待，我们的努力将继续是新颖、富有成效和极具影响力的。 。

项目成果

Racial and Ethnic Variations in Mortality Rates for Patients Undergoing Maintenance Dialysis Treated in US Territories Compared with the US 50 States.

与美国 50 个州相比，在美国领土接受维持性透析的患者死亡率的种族和民族差异。

• DOI: 10.2215/cjn.03920319
• 发表时间: 2020
• 期刊: Clinical journal of the American Society of Nephrology : CJASN
• 作者: Yan,Guofen;Shen,JennyI;Harford,Rubette;Yu,Wei;Nee,Robert;Clark,MaryJo;Flaque,Jose;Colon,Jose;Torre,Francisco;Rodriguez,Ylene;Georges,Jane;Agodoa,Lawrence;Norris,KeithC
• 通讯作者: Norris,KeithC

Confounding of Race/Ethnicity and Age in the Survival among Veterans Obtaining Dialysis in VA and Non-VA Settings.

在退伍军人管理局和非退伍军人管理局接受透析的退伍军人生存中种族/族裔和年龄的混杂。

• DOI: 10.1681/asn.2019030225
• 发表时间: 2019
• 期刊: Journal of the American Society of Nephrology : JASN
• 作者: Yan,Guofen

Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy.

• DOI: 10.1159/000514550
• 发表时间: 2021
• 期刊: American journal of nephrology
• 影响因子: 4.2
• 作者: Thurlow JS;Joshi M;Yan G;Norris KC;Agodoa LY;Yuan CM;Nee R
• 通讯作者: Nee R

Role of Age and Competing Risk of Death in the Racial Disparity of Kidney Failure Incidence after Onset of CKD.

年龄和竞争死亡风险在 CKD 发病后肾衰竭发病率种族差异中的作用。

• DOI: 10.1681/asn.0000000000000300
• 发表时间: 2024
• 期刊: Journal of the American Society of Nephrology : JASN
• 作者: Yan,Guofen;Nee,Robert;Scialla,JuliaJ;Greene,Tom;Yu,Wei;Heng,Fei;Cheung,AlfredK;Norris,KeithC
• 通讯作者: Norris,KeithC