Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center and Vanderbilt-Ingram Cancer Center, Nashville, TN, USA.
PLoS One. 2012;7(10):e48407. doi: 10.1371/journal.pone.0048407. Epub 2012 Oct 24.
We evaluated whether black race is associated with higher incidence of End Stage Renal Disease (ESRD) among a cohort of blacks and whites of similar, generally low socioeconomic status, and whether risk factor patterns differ among blacks and whites and explain the poorly understood racial disparity in ESRD. Incident diagnoses of ESRD among 79,943 black and white participants in the Southern Community Cohort Study (SCCS) were ascertained by linkage with the United States Renal Data System (USRDS) from 2002 through 2009. Person-years of follow up were calculated from date of entry into the SCCS until date of ESRD diagnosis, date of death, or September 1, 2009, whichever occurred first. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for incident ESRD among black and white participants in relation to baseline characteristics. After 329,003 person-years of follow-up, 687 incident cases of ESRD were identified in the cohort. The age-adjusted ESRD incidence rate was 273 (per 100,000) among blacks, 3.5-fold higher than the rate of 78 among whites. Risk factors for ESRD included male sex (HR = 1.6; 95% CI 1.4-1.9), low income (HR = 1.5; 95% CI 1.2-1.8 for income below vs. above $15,000), smoking (HR = 1.2; 95% CI 1.02-1.4) and histories of diabetes (HRs increasing to 9.4 (95% CI 7.4-11.9) among those with ≥20 years diabetes duration) and hypertension (HR = 2.9; 95% CI 2.3-3.7). Patterns and magnitudes of association were virtually identical among blacks and whites. After adjustment for these risk factors, blacks continued to have a higher risk for ESRD (HR = 2.4; 95% CI = 1.9-3.0) relative to whites. The black-white disparity in risk of ESRD was attenuated but not eliminated after control for known risk factors in a closely socioeconomically matched cohort. Further research characterizing biomedical factors, including CKD progression, in ESRD occurrence in these two racial groups is needed.
我们评估了在一个相似的、社会经济地位普遍较低的黑人和白人队列中，黑种人是否与更高的终末期肾病（ESRD）发病率相关，以及黑人和白人之间的风险因素模式是否不同，并解释 ESRD 中这种未被充分理解的种族差异。通过与美国肾脏数据系统（USRDS）进行链接，在 2002 年至 2009 年期间，从南方社区队列研究（SCCS）中的 79943 名黑人和白人参与者中确定了 ESRD 的新发病例诊断。从进入 SCCS 之日起至 ESRD 诊断、死亡或 2009 年 9 月 1 日（以先发生者为准）计算随访人年。使用 Cox 比例风险模型来估计黑人参与者和白人参与者与基线特征相关的 ESRD 发生率的风险比（HR）和 95%置信区间（CI）。在 329,003 人年的随访后，队列中确定了 687 例 ESRD 新发病例。调整年龄后的 ESRD 发病率为黑人 273（每 100,000 人），是白人 78 的 3.5 倍。ESRD 的危险因素包括男性（HR=1.6；95%CI 1.4-1.9）、低收入（收入低于 vs. 高于 15,000 美元时 HR=1.5；95%CI 1.2-1.8）、吸烟（HR=1.2；95%CI 1.02-1.4）和糖尿病史（HR 增加至 9.4（95%CI 7.4-11.9），糖尿病持续时间≥20 年）和高血压（HR=2.9；95%CI 2.3-3.7）。黑人与白人之间的关联模式和程度几乎相同。在调整这些危险因素后，黑人患 ESRD 的风险仍然高于白人（HR=2.4；95%CI=1.9-3.0）。在一个社会经济匹配度非常高的队列中，控制已知危险因素后，黑人和白人之间 ESRD 风险的差异虽然有所减弱，但并未消除。需要进一步研究这两个种族群体中 ESRD 发生的生物医学因素，包括 CKD 进展。
