Nilka Ríos Burrows, Pyone Cho, and Kai McKeever Bullard are with the Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA. Andrew S. Narva and Paul W. Eggers are with National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
Am J Public Health. 2014 Jun;104 Suppl 3(Suppl 3):S490-5. doi: 10.2105/AJPH.2014.301942. Epub 2014 Apr 22.
We assessed survival in American Indians and Alaska Natives (AI/ANs) with end-stage renal disease attributed to diabetes who initiated hemodialysis between 1995 and 2009.
Follow-up extended from the first date of dialysis in the United States Renal Data System until December 31, 2010, kidney transplantation, or death. We used the Kaplan-Meier method to compute survival on dialysis by age and race/ethnicity and Cox regression analysis to compute adjusted hazard ratios (HRs).
Our study included 510,666 persons-48% Whites, 2% AI/AN persons, and 50% others. Median follow-up was 2.2 years (interquartile range = 1.1-4.1 years). At any age, AI/AN persons survived longer on hemodialysis than Whites; this finding persisted after adjusting for baseline differences. Among AI/AN individuals, those with full Indian blood ancestry had the lowest adjusted risk of death compared with Whites (HR = 0.58; 95% confidence interval = 0.55, 0.61). The risk increased with declining proportion of AI/AN ancestry.
Survival on dialysis was better among AI/AN than White persons with diabetes. Among AI/AN persons, the inverse relationship between risk of death and level of AI/AN ancestry suggested that cultural or hereditary factors played a role in survival.
我们评估了 1995 年至 2009 年间接受血液透析的归因于糖尿病的终末期肾病的美洲印第安人和阿拉斯加原住民（AI/ANs）的生存情况。
随访时间从美国肾脏数据系统中透析的第一天开始，直到 2010 年 12 月 31 日、进行肾移植或死亡。我们使用 Kaplan-Meier 方法按年龄和种族/族裔计算透析期间的生存情况，并使用 Cox 回归分析计算调整后的危险比（HRs）。
我们的研究包括 510,666 人-48%为白人，2%为 AI/AN 人，50%为其他人。中位随访时间为 2.2 年（四分位间距=1.1-4.1 年）。在任何年龄，AI/AN 人在血液透析上的生存时间都长于白人；这一发现在调整了基线差异后仍然存在。在 AI/AN 个体中，与白人相比，具有完整印第安人血统的人死亡风险调整后最低（HR=0.58；95%置信区间=0.55,0.61）。随着 AI/AN 血统比例的下降，风险增加。
与白人糖尿病患者相比，血液透析期间 AI/AN 患者的生存率更高。在 AI/AN 人群中，死亡风险与 AI/AN 血统水平之间的反比关系表明，文化或遗传因素在生存中发挥了作用。
