Division of Pulmonary Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico.
Division of Pulmonary Critical Care Medicine, Weill Cornell Medical College, Houston Methodist Hospital, Houston, Texas.
J Heart Lung Transplant. 2020 Apr;39(4):321-330. doi: 10.1016/j.healun.2019.11.024. Epub 2020 Jan 24.
Prior research has suggested that the prevalence and outcomes of pulmonary arterial hypertension (PAH) may vary by race or ethnicity. However, these studies have been limited by small sample size or methodological techniques relying on epidemiologic data. The purpose of this study is to evaluate the relationship between race/ethnicity and survival in a large U.S.-based prospective multicenter registry.
Patients in the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL), a 5-year observational study of Group 1 PAH, were categorized by race/ethnicity. Baseline hemodynamic characteristics, clinical characteristics, and medication use was described. The relationship between race/ethnicity and outcome was evaluated by Kaplan-Meier and Cox proportional hazards modeling techniques. Left-truncation analysis, which adjusted for time from diagnosis to study enrollment, was used to minimize the effect of survivor bias.
This analysis included 3,046 patients; 2,202 identified as white, 393 as black, 263 as Hispanic, 100 as Asian or Pacific Islander, and 88 as other. Unadjusted Kaplan-Meier survival analysis indicated that white patients had the lowest survival rates. After adjusting for variables of prognostic impact, race/ethnicity was no longer significantly associated with survival. Other results showed that black patients were more likely to have connective tissue disease-associated PAH, Hispanic patients were more likely to have portopulmonary hypertension, and Asian patients were more likely to have congenital heart disease-associated PAH.
Analysis of the REVEAL registry did not find race/ethnicity to be a significant predictor of mortality. This is the largest analysis to date evaluating the role of race/ethnicity on outcomes in PAH.
先前的研究表明，肺动脉高压（PAH）的患病率和结局可能因种族或民族而异。然而，这些研究受到样本量小或依赖于流行病学数据的方法技术的限制。本研究旨在评估在美国进行的一项大型前瞻性多中心登记研究中种族/民族与生存之间的关系。
登记处评估早期和长期 PAH 疾病管理（REVEAL）中的患者，这是一项为期 5 年的 1 组 PAH 的观察性研究，根据种族/民族进行分类。描述了基线血流动力学特征、临床特征和药物使用情况。通过 Kaplan-Meier 和 Cox 比例风险建模技术评估种族/民族与结局之间的关系。采用左截断分析（left-truncation analysis），调整从诊断到研究入组的时间，以最小化幸存者偏差的影响。
这项分析包括 3046 名患者；2202 名被确定为白人，393 名黑人，263 名西班牙裔，100 名亚洲或太平洋岛民，88 名其他种族。未经调整的 Kaplan-Meier 生存分析表明，白人患者的生存率最低。在调整了预后相关变量后，种族/民族与生存不再显著相关。其他结果表明，黑人患者更可能患有结缔组织病相关的 PAH，西班牙裔患者更可能患有门脉高压相关的 PAH，亚洲患者更可能患有先天性心脏病相关的 PAH。
REVEAL 登记处的分析并未发现种族/民族是死亡率的重要预测因素。这是迄今为止评估 PAH 结局中种族/民族作用的最大分析。
