Brancati F L, Whittle J C, Whelton P K, Seidler A J, Klag M J
Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Md 21287-6231.
JAMA. 1992 Dec 2;268(21):3079-84.
To investigate whether the excess incidence of diabetic end-stage renal disease (ESRD) among African Americans could be explained by racial differences in putative ESRD risk factors.
Population-based, ecologic study using the 1981 and 1982 Maryland Statewide Household Hypertension Survey for data on risk factor prevalence.
A total of 2.1 million adults residing within the boundaries of the Maryland Regional ESRD Registry, grouped by race and ZIP code into 26 subpopulations.
Incidence rates of treatment for diabetic ESRD between 1980 and 1985 from the Maryland Regional ESRD Registry by subpopulation.
Between 1980 and 1985, 442 persons entered treatment for diabetic ESRD. At the level of the subpopulation, diabetic ESRD incidence was positively associated with black race (relative risk [RR], 3.42; 95% confidence interval [CI], 2.84 to 4.13), prevalence of diabetes (RR, 2.35; 95% CI, 1.92 to 2.87), prevalence of poorly controlled hypertension (RR, 1.80; 95% CI, 1.45 to 1.86), lack of a regular source of health care (RR, 1.82; 95% CI, 1.62 to 2.05), and lower socioeconomic status as indicated by lack of college education (RR, 1.41; 95% CI, 1.32 to 1.52) (all, P < .0001). After adjusting for these risk factors, black race remained strongly associated with the overall incidence of diabetic ESRD (RR, 2.70; 95% CI, 1.89 to 3.86; P < .0001). Further analyses suggested that this excess risk among blacks was confined to ESRD related to non-insulin-dependent diabetes (RR, 4.80; 95% CI, 3.09 to 7.46; P < .0001); blacks were at no higher risk than were whites for ESRD related to insulin-dependent diabetes (RR, 0.90; 95% CI, 0.52 to 1.55; P = .70).
These data suggest that the excess incidence of diabetic ESRD among blacks is not fully explained by a higher prevalence of diabetes or hypertension in blacks or by racial differences in age, socioeconomic status, or access to health care. Instead, they suggest an increased susceptibility to ESRD resulting from non-insulin-dependent diabetes among blacks as compared with whites.
探讨非裔美国人中糖尿病终末期肾病（ESRD）的发病率过高是否可由假定的ESRD危险因素的种族差异来解释。
基于人群的生态学研究，利用1981年和1982年马里兰州全州家庭高血压调查获取危险因素患病率数据。
共有210万居住在马里兰州地区ESRD登记处范围内的成年人，按种族和邮政编码分为26个亚人群。
1980年至1985年马里兰州地区ESRD登记处按亚人群划分的糖尿病ESRD治疗发病率。
1980年至1985年期间，442人开始接受糖尿病ESRD治疗。在亚人群层面，糖尿病ESRD发病率与黑人种族呈正相关（相对危险度[RR]，3.42；95%置信区间[CI]，2.84至4.13）、糖尿病患病率（RR，2.35；95%CI，1.92至2.87）、血压控制不佳的患病率（RR，1.80；95%CI，1.45至1.86）、缺乏固定的医疗保健来源（RR，1.82；95%CI，1.62至2.05）以及因未接受大学教育而表明的较低社会经济地位（RR，1.41；95%CI，1.32至1.52）（所有P均<.0001）。在对这些危险因素进行调整后，黑人种族与糖尿病ESRD的总体发病率仍密切相关（RR，2.70；95%CI，1.89至3.86；P<.0001）。进一步分析表明，黑人中的这种额外风险仅限于与非胰岛素依赖型糖尿病相关的ESRD（RR，4.80；95%CI，3.09至7.46；P<.0001）；与胰岛素依赖型糖尿病相关的ESRD，黑人的风险并不高于白人（RR，0.90；9%CI，0.52至1.55；P=.70）。
这些数据表明，黑人中糖尿病ESRD发病率过高不能完全用黑人中较高的糖尿病或高血压患病率或年龄、社会经济地位或获得医疗保健方面的种族差异来解释。相反，这些数据表明，与白人相比，黑人因非胰岛素依赖型糖尿病导致的ESRD易感性增加。
