Medicine and Health Promotion Institute, Tehran, Iran.
Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.
J Diabetes Investig. 2017 Jul;8(4):590-599. doi: 10.1111/jdi.12618. Epub 2017 Apr 19.
AIMS/INTRODUCTION: Diabetes, hypertension, and obesity increase the risk of chronic kidney disease and associated mortality. Race and socioeconomic status (SES) differences in the effects of these risk factors are, however, still unknown. The current study aimed to investigate whether or not race and SES alter the effects of diabetes, hypertension, and obesity on mortality due to renal disease.
Data came from the Americans' Changing Lives Study, 1986-2011, a nationally representative prospective cohort of adults with 25 years of follow up. The study included 3,361 adults aged 25 years and older who were followed for up to 25 years. The outcome was death from renal disease. Diabetes, hypertension, and obesity were the main predictors. Race and SES (education, income, and employment) were moderators. Health behaviors and health status at baseline were covariates. We used Cox proportional hazards models for data analysis.
In separate models, diabetes, hypertension, and obesity at baseline were associated with a higher risk of death from renal disease. From our SES indicators, education and income interacted with diabetes, hypertension, and obesity on death from renal disease. In a consistent pattern, diabetes, hypertension, and obesity showed stronger effects on the risk of death from renal disease among high-SES groups compared with low-SES individuals. Race and employment did not alter the effects of diabetes, hypertension and obesity on the risk of death from renal disease.
Social groups differ in how diabetes, hypertension, and obesity influence health outcomes over long-term periods. Elimination of disparities in renal disease mortality in the USA requires understanding of the complex and non-linear effects of socioeconomic and medical risk factors on health outcomes. Multidisciplinary programs and policies are required to reduce social inequality in renal disease burden caused by diabetes, hypertension, and obesity.
目的/引言：糖尿病、高血压和肥胖会增加慢性肾脏病和相关死亡率的风险。然而，这些风险因素的种族和社会经济地位（SES）差异的影响仍不清楚。本研究旨在调查种族和 SES 是否改变了糖尿病、高血压和肥胖对肾脏病死亡率的影响。
数据来自于 1986-2011 年的“美国人生活变化研究”，这是一项具有 25 年随访时间的全国代表性成年人前瞻性队列研究。该研究包括了 3361 名年龄在 25 岁及以上的成年人，随访时间长达 25 年。研究的结果是肾脏病导致的死亡。糖尿病、高血压和肥胖是主要预测因素。种族和 SES（教育、收入和就业）是调节因素。健康行为和基线健康状况是协变量。我们使用 Cox 比例风险模型进行数据分析。
在单独的模型中，基线时的糖尿病、高血压和肥胖与肾脏病死亡风险增加有关。从我们的 SES 指标来看，教育和收入与糖尿病、高血压和肥胖对肾脏病死亡的相互作用。在一个一致的模式中，与 SES 较低的个体相比，糖尿病、高血压和肥胖对高 SES 群体的肾脏病死亡风险的影响更大。种族和就业没有改变糖尿病、高血压和肥胖对肾脏病死亡风险的影响。
不同的社会群体在长期内，糖尿病、高血压和肥胖对健康结果的影响方式不同。要消除美国肾脏病死亡率的差异，需要了解社会经济和医疗风险因素对健康结果的复杂和非线性影响。需要制定多学科的计划和政策，以减少糖尿病、高血压和肥胖导致的肾脏病负担方面的社会不平等。
