Li Suying, McAlpine Donna D, Liu Jiannong, Li Shuling, Collins Allan J
United States Renal Data System Coordinating Center, Minneapolis Medical Research Foundation, Minneapolis, MN, USA.
Adv Ren Replace Ther. 2004 Jan;11(1):5-13. doi: 10.1053/j.arrt.2003.10.005.
In the United States, the age-and-gender-adjusted incident rate of end-stage renal disease (ESRD) for blacks has been 4 times higher than that for whites. We analyzed patient information and medical services contained in the Medicare 5% random sample database. White (n = 977,436) and black (n = 77,800) Medicare enrollees who were at least 65 years old on January 1, 1997, were followed from 1999 to 2001. Hierarchical Cox regression models were used to estimate the relative risk of ESRD for blacks (with reference to whites) after adjustment for age and gender, socioeconomic status, special health conditions (anemia, chronic obstructive pulmonary disease, cardiovascular disease), primary causal diseases of ESRD (eg, diabetes, hypertension), diabetes care and preventive care (eg, hemoglobin A1c or lipid testing), and physician visits for primary or specialty care. The relative risk of ESRD for blacks (with reference to whites) was 3.52 (95% confidence interval [CI], 3.25-3.80) after adjustment for age and gender; 2.90 (95% CI, 2.67-3.15) after adjustment for socioeconomic status and special health conditions; and 2.11 (95% CI, 1.94-2.30) after further adjustment for primary causal diseases of ESRD, diabetes care and preventive care, and physician visits. We conclude that a higher prevalence of primary causal diseases of ESRD and lower access to diabetes care, preventive care, and primary physician visits in blacks compared with whites partially accounts for the racial difference in the incidence of ESRD in the elderly Medicare population. Public health policy should focus on improving access to care, which may lower the burden of ESRD in minority and other at-risk populations.
在美国，黑人终末期肾病（ESRD）的年龄和性别调整发病率一直是白人的4倍。我们分析了医疗保险5%随机样本数据库中的患者信息和医疗服务情况。对1997年1月1日时至少65岁的977436名白人及77800名黑人医疗保险参保者进行了1999年至2001年的随访。采用分层Cox回归模型，在对年龄、性别、社会经济地位、特殊健康状况（贫血、慢性阻塞性肺疾病、心血管疾病）、ESRD的主要病因（如糖尿病、高血压）、糖尿病护理和预防护理（如糖化血红蛋白或血脂检测）以及初级或专科护理的医生就诊情况进行调整后，估计黑人（以白人为参照）患ESRD的相对风险。在对年龄和性别进行调整后，黑人患ESRD的相对风险为3.52（95%置信区间[CI]，3.25 - 3.80）；在对社会经济地位和特殊健康状况进行调整后为2.90（95% CI，2.67 - 3.15）；在对ESRD的主要病因、糖尿病护理和预防护理以及医生就诊情况进行进一步调整后为2.11（95% CI，1.94 - 2.30）。我们得出结论，与白人相比，黑人中ESRD主要病因的患病率较高，且获得糖尿病护理、预防护理和初级医生就诊的机会较少，这在一定程度上解释了老年医疗保险人群中ESRD发病率的种族差异。公共卫生政策应侧重于改善医疗服务的可及性，这可能会减轻少数族裔和其他高危人群的ESRD负担。
