Department of Inter-Organ Communication Research, Niigata University Graduate School of Medical and Dental Sciences, Japan.
Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Japan.
Intern Med. 2022 Oct 1;61(19):2831-2839. doi: 10.2169/internalmedicine.8981-21. Epub 2022 Feb 26.
Objective The survival advantage of females over males is lost in dialysis patients in many countries. Japanese female hemodialysis patients, however, have a survival advantage over their male counterparts. This study explored causes of death that contribute to sex differences in all-cause mortality in Japanese dialysis patients. Methods Data from the Japanese Society for Dialysis Therapy registry and National Vital Statistics from 2017 and 2018 were used. Standardized mortality ratios, male-to-female mortality rate ratios, and age-adjusted differences between sexes were calculated for all-cause, cardiovascular, and non-cardiovascular mortality, as well as cause-specific mortality, in dialysis patients and the general population. Results During the 2-year study period, 41,006 and 21,254 deaths occurred in 417,740 and 225,292 patient-years in male and female dialysis patients, respectively. The age-standardized all-cause mortality ratio was 1.21 (95% confidence interval, 1.20-1.23) for male patients compared to female patients. The male-to-female mortality rate ratio for cardiovascular disease was about 1.4 in younger age categories but closer to 1.0 in older age categories. Conversely, the ratio for non-cardiovascular disease was about 1.3 in older age categories but closer to 1.0 in younger age categories. Death from infectious disease, malignancy, and heart failure contributed to 38.4%, 22.7%, and 12.1%, respectively, of the male-to-female difference in all-cause mortality of dialysis patients. Conclusion Low cardiovascular mortality in younger age categories and low non-cardiovascular mortality in older age categories contributed to the survival advantage of female Japanese dialysis patients. Infectious disease was the greatest contributor to sex differences in all-cause mortality.
在许多国家，透析患者中女性的生存率高于男性。然而，日本女性血液透析患者的生存率高于男性。本研究旨在探讨导致日本透析患者全因死亡率性别差异的原因。
本研究使用了日本透析治疗学会登记处和 2017 年和 2018 年国家生命统计数据。计算了透析患者和普通人群全因、心血管和非心血管死亡率以及特定原因死亡率的标准化死亡率比、男女死亡率比以及性别间年龄调整差异。
在为期 2 年的研究期间，417740 名男性和 225292 名女性透析患者中分别有 41006 例和 21254 例死亡。与女性相比，男性的全因死亡率标准化比为 1.21（95%置信区间，1.20-1.23）。在年龄较小的类别中，心血管疾病的男女死亡率比约为 1.4，但在年龄较大的类别中接近 1.0。相反，在年龄较大的类别中，非心血管疾病的比值约为 1.3，但在年龄较小的类别中接近 1.0。传染病、恶性肿瘤和心力衰竭导致透析患者全因死亡率的性别差异分别占 38.4%、22.7%和 12.1%。
年轻年龄段较低的心血管死亡率和老年年龄段较低的非心血管死亡率导致了日本女性透析患者的生存优势。传染病是导致全因死亡率性别差异的最大因素。
