透析を受けている患者の生存率と人種と年齢の関連性
Lauren M Kucirka1, Morgan E Grams, Justin Lessler
1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
JAMA
|August 11, 2011
まとめ
50歳未満の黒人透析患者は,白人患者よりも死亡率が高く,高齢の黒人の成人で観察された全生存優位とは対照的です. 年齢は,透析患者における人種による生存率の違いを著しく変化させる.
科学分野:
- ネフロロジーはネフロロジーを用います.
- 公衆衛生は公衆衛生である.
- エピデミオロジー エピデミオロジー
背景:
- 以前の研究によると,透析を受けている黒人は,医療における人種的格差にもかかわらず,白人よりも生存率が高いことが示されています.
- この黒人透析患者の生存率の優位性は,慢性腎臓病の黒人患者の生存率の低下と矛盾している.
- 競合するリスクとして年齢と腎臓移植が,透析患者における人種間の生存率の違いに影響を及ぼすという仮説を立てた.
研究 の 目的:
- 透析患者の間で人種による死亡率の違いを推定する.
- 死亡率の分析において,効果変化因子としての年齢と,競合するリスクとして腎臓移植を考慮すること.
- 透析患者の生存における人種差異に対する年齢と移植の影響を調査する.
主な方法:
- 観察コホート研究では,米国の腎臓データシステム (1995-2009) から1,330,007人のインシデント末期腎臓病患者が分析されました.
- 多変数,年齢分層のコックス比例リスクと競合するリスクモデルが採用されました.
- 主なアウトカムは,透析を受けている黒人対白人の患者の死亡でした.
主要な成果:
- 全体的に,黒人の透析患者は白人の患者 (63.5%) に比べて死亡率 (57.1%) が低く,調整された危険比 (aHR) は0.84.8であった.
- しかし,年齢によって層分化され,移植を競合するリスクとして考慮すると,18歳から50歳までの黒人患者は著しく高い死亡率を示しました.
- 具体的には,死亡率は18-30 (aHR,1.93),31-40 (aHR,1.46),41-50 (aHR,1.12) の年齢層の黒人患者で高かったが,年上層の年齢層 (51歳以上) は黒人患者の生存優位性を示した.
結論:
- 白人患者と比較して黒人の透析患者の全体的な死亡リスクの低下は,主に高齢者 (51歳以上) で観察されています.
- 若い黒人透析患者 (50歳未満) は,白人患者と比較して,死亡のリスクが著しく高い.
- 年齢は,透析を受けている末期腎疾患患者の観察された人種間の生存差異を修正する重要な要因である.
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