种族和年龄与透析患者的存活率的关联
Lauren M Kucirka1, Morgan E Grams, Justin Lessler
1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
JAMA
|August 11, 2011
概括
50岁以下的黑人透析患者的死亡率高于白人患者,与老年黑人成年人观察到的整体生存优势相反. 年龄显著改变了透析患者的基于种族的生存差异.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 公共卫生 公共卫生
- 流行病学 流行病学
背景情况:
- 之前的研究表明,在透析中,黑人比白人生存率更高,尽管在医疗保健中存在种族差异.
- 这种观察到的黑人透析患者的生存优势与黑人慢性病患者的低生存率不一致.
- 假设年龄和脏移植作为竞争的风险影响透析患者的种族生存差异.
研究的目的:
- 为了估计透析患者的种族死亡率差异.
- 在分析死亡率时,要考虑年龄作为效果修饰因素和移植作为竞争风险.
- 调查年龄和移植对透析患者存活时间的种族差异的影响.
主要方法:
- 一项观察性队列研究分析了来自美国脏数据系统 (1995-2009) 的1,330,007例末期脏病患者.
- 采用多变量,年龄分层的Cox比例危险和竞争风险模型.
- 主要结局是黑人死亡,而白人患者接受透析.
主要成果:
- 总体而言,黑人透析患者的死亡率 (57.1%) 与白人患者 (63.5%) 相比较低,调整后危险比率 (aHR) 为0.84.
- 然而,当按年龄分层并将移植视为竞争风险时,年龄在18-50岁的黑人患者的死亡率显著增加.
- 具体来说,在18-30 (aHR,1.93),31-40 (aHR,1.46) 和41-50 (aHR,1.12) 年龄组的黑人患者的死亡率更高,而老年人群 (51+) 显示黑人患者的生存优势.
结论:
- 与白人患者相比,黑人透析患者的整体较低的死亡风险主要观察到的是老年人 (51岁及以上).
- 年轻的黑人透析患者 (50岁以下) 与白人同行相比,死亡风险明显更高.
- 年龄是一个关键因素,它改变了在接受透析的末期病患者中观察到的种族生存差异.
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