Eisenstein Eric L, Sun Jie L, Anstrom Kevin J, Stafford Judith A, Szczech Lynda A, Muhlbaier Lawrence H, Mark Daniel B
Duke Clinical Research Institute, Durham, NC 27715, USA.
Am J Med. 2009 Feb;122(2):170-80. doi: 10.1016/j.amjmed.2008.08.025.
Residence in a lower-income area has been associated with higher mortality among patients receiving dialysis. We sought to determine whether these differences persist and whether the effect of income-area on mortality is different for African Americans versus patients of other races.
We evaluated relationships between lower- and higher-income versus middle-income area residence and mortality to 5 years after adjusting for differences in baseline clinical, dialysis facility, and socioeconomic characteristics in 186,424 adult patients with end-stage renal disease initiating hemodialysis at stand-alone facilities between 1996 and 1999. We also compared mortality differences between race and income level groups using non-African Americans residing in middle-income areas as the reference group.
Patients with end-stage renal disease who reside in lower-income areas were younger and more frequently African American. After adjustment, there were no mortality differences among income level groups. However, African Americans in all income level groups had lower adjusted mortality compared with the reference group (lower-income hazard ratio [HR]=0.771, 95% confidence interval [CI], 0.736-0.808; middle-income HR=0.755, 95% CI, 0.730-0.781; higher-income HR=0.809, 95% CI, 0.764-0.857), whereas adjusted mortality was similar among non-African-American income level groups (lower-income HR=1.019, 95% CI, 0.976-1.064; higher-income HR=1.003, 95% CI, 0.968-1.039).
Adjusted survival for patients receiving hemodialysis in all income areas was similar. However, this result masks the paradoxically higher survival for African American versus patients of other race and demonstrates the need to adjust for differences in demographic, clinical, provider, and socioeconomic status characteristics.
居住在低收入地区与接受透析治疗的患者较高的死亡率相关。我们试图确定这些差异是否持续存在，以及收入地区对死亡率的影响在非裔美国人与其他种族患者之间是否不同。
我们评估了在1996年至1999年间于独立透析机构开始进行血液透析的186,424例终末期肾病成年患者中，低收入和高收入地区与中等收入地区居住情况与5年死亡率之间的关系。我们还以居住在中等收入地区的非非裔美国人为参照组，比较了种族和收入水平组之间的死亡率差异。
居住在低收入地区的终末期肾病患者更年轻，且非裔美国人更为常见。经过调整后，各收入水平组之间没有死亡率差异。然而，与参照组相比，所有收入水平组中的非裔美国人调整后的死亡率均较低（低收入组风险比[HR]=0.771，95%置信区间[CI]为0.736 - 0.808；中等收入组HR=0.755，95%CI为0.730 - 0.781；高收入组HR=0.809，95%CI为0.764 - 0.857），而非非裔美国人收入水平组之间调整后的死亡率相似（低收入组HR=1.019，95%CI为0.976 - 1.064；高收入组HR=1.003，95%CI为0.968 - 1.039）。
所有收入地区接受血液透析患者的调整后生存率相似。然而，这一结果掩盖了非裔美国人与其他种族患者相比生存情况反常地更好这一现象，并表明需要对人口统计学、临床、医疗服务提供者和社会经济状况特征的差异进行调整。
