白人和黑人美国人的高血压与肾细胞癌风险。
Hypertension and risk of renal cell carcinoma among white and black Americans.
机构信息
Division of Cancer Epidemiology and Genetics, Occupational and Environmental Epidemiology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-7240, USA.
出版信息
Epidemiology. 2011 Nov;22(6):797-804. doi: 10.1097/EDE.0b013e3182300720.
BACKGROUND
Renal cell carcinoma and hypertension (a well-established renal cancer risk factor) are both more frequent among blacks than whites in the United States. The association between hypertension and renal cell carcinoma has not been examined in black Americans. We investigated the hypertension-renal cancer association by race, and we assessed the role of hypertension in the racial disparity of renal cancer incidence.
METHODS
Participants were enrolled in a population-based case-control study in Detroit and Chicago during 2002-2007 (number of cases: 843 whites, 358 blacks; number of controls: 707 whites, 519 blacks). Participants reported their history of hypertension and antihypertensive drug use. We used unconditional logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs), adjusted for demographic characteristics, smoking, body mass index, and family history of cancer.
RESULTS
Hypertension doubled renal cancer risk (OR = 2.0 [CI = 1.7-2.5]) overall. For whites, the OR was 1.9 (CI = 1.5-2.4), whereas for blacks it was 2.8 (2.1-3.8) (P for interaction = 0.11). ORs increased with time after hypertension diagnosis (P for trend <0.001), reaching 4.1 (CI = 2.3-7.4) for blacks and 2.6 (CI = 1.7-4.1) for whites after 25 years. ORs for poorly controlled hypertension were 4.5 (CI = 2.3-8.8) for blacks and 2.1 (CI = 1.2-3.8) for whites. If these estimates correctly represent causal effects and if, hypothetically, hypertension could be prevented entirely among persons aged 50-79 years, the black/white disparity in renal cancer could be reversed among women and reduced by two-thirds among men.
CONCLUSIONS
Hypertension is a risk factor for renal cancer among both blacks and whites, and might explain a substantial portion of the racial disparity in renal cancer incidence. Preventing and controlling hypertension might reduce renal cancer incidence, adding to the known benefits of blood pressure control for heart disease and stroke reduction, particularly among blacks.
背景
在美国，黑人群体中肾癌和高血压（已被证实的肾癌风险因素）的发病率均高于白人群体。然而，黑人群体中高血压与肾癌之间的关系尚未得到研究。我们通过种族分析了高血压与肾癌之间的关系，并评估了高血压在肾癌发病率的种族差异中的作用。
方法
2002 年至 2007 年期间，我们在底特律和芝加哥开展了一项基于人群的病例对照研究，纳入了参与者（病例：843 名白种人，358 名黑种人；对照：707 名白种人，519 名黑种人）。参与者报告了他们的高血压病史和使用降压药物的情况。我们使用非条件逻辑回归计算了比值比（OR）及其 95%置信区间（CI），调整了人口统计学特征、吸烟、体重指数和癌症家族史。
结果
高血压使肾癌风险增加了一倍（OR=2.0 [95%CI=1.7-2.5]）。对于白种人，OR 为 1.9（95%CI=1.5-2.4），而对于黑种人，OR 为 2.8（95%CI=2.1-3.8）（P 交互=0.11）。OR 随着高血压诊断后时间的延长而增加（趋势 P<0.001），黑人的 OR 达到 4.1（95%CI=2.3-7.4），白人的 OR 达到 2.6（95%CI=1.7-4.1），这是在 25 年后。对于控制不佳的高血压，黑人的 OR 为 4.5（95%CI=2.3-8.8），白人的 OR 为 2.1（95%CI=1.2-3.8）。如果这些估计能够正确反映因果效应，并且假设在 50-79 岁的人群中完全可以预防高血压，那么女性的肾癌黑种人和白种人之间的发病差异可能会逆转，男性的发病差异也可能减少三分之二。
结论
高血压是黑人和白人患肾癌的一个风险因素，可能解释了肾癌发病率的种族差异的很大一部分。预防和控制高血压可能会降低肾癌的发病率，这也增加了控制血压对降低心脏病和中风风险的已知益处，特别是在黑人群体中。
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