Krishnan E, Hubert H B
Division of Rheumatology, Department of Medicine, University of Pittsburgh, S709 BST South, 3500 Terrace St, Pittsburgh, PA 15261, USA.
Ann Rheum Dis. 2006 Nov;65(11):1500-5. doi: 10.1136/ard.2005.040907. Epub 2006 Apr 20.
To study ethnic differences in mortality from systemic lupus erythematosus (lupus) in two large, population-based datasets.
We analysed the national death data (1979-98) from the National Center for Health Statistics (Hyattsville, Maryland, USA) and hospitalisation data (1993-2002) from the Nationwide Inpatient Sample (NIS), the largest hospitalisation database in the US.
The overall, unadjusted, lupus mortality in the National Center for Health Statistics data was 4.6 per million, whereas the proportion of in-hospital mortality from the NIS was 2.9%. African-Americans had disproportionately higher mortality risk than Caucasians (all-cause mortality relative risk adjusted for age = 1.24 (women), 1.36 (men); lupus mortality relative risk = 3.91 (women), 2.40 (men)). Excess risk was found among in-hospital deaths (odds ratio adjusted for age = 1.4 (women), 1.3 (men)). Lupus death rates increased overall from 1979 to 98 (p<0.001). The proportional increase was greatest among African-Americans. Among Caucasian men, death rates declined significantly (p<0.001), but rates did not change substantially for African-American men. The African-American:Caucasian mortality ratio rose with time among men, but there was little change among women. In analyses of the NIS data adjusted for age, the in-hospital mortality risk decreased with time among Caucasian women (p<0.001).
African-Americans with lupus have 2-3-fold higher lupus mortality risk than Caucasians. The magnitude of the risk disparity is disproportionately higher than the disparity in all-cause mortality. A lupus-specific biological factor, as opposed to socioeconomic and access-to-care factors, may be responsible for this phenomenon.
在两个基于人群的大型数据集中研究系统性红斑狼疮（狼疮）死亡率的种族差异。
我们分析了美国国家卫生统计中心（马里兰州海茨维尔）的全国死亡数据（1979 - 1998年）以及美国最大的住院数据库全国住院样本（NIS）的住院数据（1993 - 2002年）。
国家卫生统计中心数据中未经调整的狼疮总体死亡率为每百万4.6例，而NIS中的住院死亡率为2.9%。非裔美国人的死亡风险比白种人高得多（年龄调整后的全因死亡相对风险 = 1.24（女性），1.36（男性）；狼疮死亡相对风险 = 3.91（女性），2.40（男性））。在住院死亡中发现了额外风险（年龄调整后的比值比 = 1.4（女性），1.3（男性））。从1979年到1998年，狼疮死亡率总体上升（p<0.001）。比例增幅在非裔美国人中最大。在白种男性中，死亡率显著下降（p<0.001），但非裔美国男性的死亡率没有实质性变化。男性中非裔美国人与白种人的死亡率比值随时间上升，但女性中变化不大。在对NIS数据进行年龄调整的分析中，白种女性的住院死亡风险随时间降低（p<0.001）。
患有狼疮的非裔美国人的狼疮死亡风险比白种人高2至3倍。风险差距的幅度比全因死亡率的差距高得多。这种现象可能是由狼疮特异性生物因素而非社会经济和医疗可及性因素导致的。
