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Survival Disparity of African American Versus Non-African American Patients With ESRD Due to SLE.
Am J Kidney Dis 2015; 66(4):630-7AJ

Abstract

BACKGROUND

A recent study showed an increased risk of death in African Americans compared with whites with end-stage renal disease (ESRD) due to lupus nephritis (LN). We assessed the impact of age stratification, socioeconomic factors, and kidney transplantation on the disparity in patient survival among African American versus non-African American patients with LN-caused ESRD, compared with other causes.

STUDY DESIGN

Retrospective cohort study.

SETTING & PARTICIPANTS

Using the US Renal Data System database, we identified 12,352 patients with LN-caused ESRD among 1,132,202 patients who initiated maintenance dialysis therapy from January 1, 1995, through December 31, 2006, and were followed up until December 31, 2010.

PREDICTORS

Baseline demographics and comorbid conditions, Hispanic ethnicity, socioeconomic factors (employment status, Medicare/Medicaid insurance, and area-level median household income based on zip code as obtained from the 2000 US census), and kidney transplantation as a time-dependent variable.

OUTCOME

All-cause mortality.

MEASUREMENTS

Multivariable Cox and competing-risk regressions.

RESULTS

Mean duration of follow-up in the LN-caused ESRD and other-cause ESRD cohorts were 6.24±4.20 (SD) and 4.06±3.61 years, respectively. 6,106 patients with LN-caused ESRD (49.43%) and 853,762 patients with other-cause ESRD (76.24%) died during the study period (P<0.001). Patients with LN-caused ESRD were significantly younger (mean age, 39.92 years) and more likely women (81.65%) and African American (48.13%) than those with other-cause ESRD. In the fully adjusted multivariable Cox regression model, African American (vs non-African American) patients with LN-caused ESRD had significantly increased risk of death at age 18 to 30 years (adjusted HR, 1.43; 95% CI, 1.24-1.65) and at age 31 to 40 years (adjusted HR, 1.17; 95% CI, 1.02-1.34). Among patients with other-cause ESRD, African Americans were at significantly increased risk at age 18 to 30 years (adjusted HR, 1.17; 95% CI, 1.11-1.22).

LIMITATIONS

We used zip code-based median household income as a surrogate for patient income. Residual socioeconomic confounders may exist.

CONCLUSIONS

African Americans are at significantly increased risk of death compared with non-African Americans with LN-caused ESRD at age 18 to 40 years, a racial disparity risk that is 10 years longer than that in the general ESRD population. Accounting for area-level median household income and transplantation significantly attenuated the disparity in mortality of African American versus non-African American patients with LN-caused ESRD.

Authors+Show Affiliations

Nephrology, Walter Reed National Military Medical Center, Bethesda, MD. Electronic address: robert.nee.civ@mail.mil.Nephrology, Tripler Army Medical Center, Honolulu, HI.Nephrology, Walter Reed National Military Medical Center, Bethesda, MD.Nephrology, Walter Reed National Military Medical Center, Bethesda, MD.Nephrology, Walter Reed National Military Medical Center, Bethesda, MD.National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.Nephrology, Walter Reed National Military Medical Center, Bethesda, MD.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

26002293

Citation

Nee, Robert, et al. "Survival Disparity of African American Versus Non-African American Patients With ESRD Due to SLE." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 66, no. 4, 2015, pp. 630-7.
Nee R, Martinez-Osorio J, Yuan CM, et al. Survival Disparity of African American Versus Non-African American Patients With ESRD Due to SLE. Am J Kidney Dis. 2015;66(4):630-7.
Nee, R., Martinez-Osorio, J., Yuan, C. M., Little, D. J., Watson, M. A., Agodoa, L., & Abbott, K. C. (2015). Survival Disparity of African American Versus Non-African American Patients With ESRD Due to SLE. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 66(4), pp. 630-7. doi:10.1053/j.ajkd.2015.04.011.
Nee R, et al. Survival Disparity of African American Versus Non-African American Patients With ESRD Due to SLE. Am J Kidney Dis. 2015;66(4):630-7. PubMed PMID: 26002293.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Survival Disparity of African American Versus Non-African American Patients With ESRD Due to SLE. AU - Nee,Robert, AU - Martinez-Osorio,Jorge, AU - Yuan,Christina M, AU - Little,Dustin J, AU - Watson,Maura A, AU - Agodoa,Lawrence, AU - Abbott,Kevin C, Y1 - 2015/05/19/ PY - 2014/06/18/received PY - 2015/04/05/accepted PY - 2015/5/24/entrez PY - 2015/5/24/pubmed PY - 2015/12/30/medline KW - African American KW - Racial disparity KW - US Renal Data System (USRDS) KW - all-cause mortality KW - competing risk KW - dialysis KW - end-stage renal disease (ESRD) KW - kidney transplantation KW - lupus nephritis KW - survival disparity KW - systemic lupus erythematosus (SLE) SP - 630 EP - 7 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am. J. Kidney Dis. VL - 66 IS - 4 N2 - BACKGROUND: A recent study showed an increased risk of death in African Americans compared with whites with end-stage renal disease (ESRD) due to lupus nephritis (LN). We assessed the impact of age stratification, socioeconomic factors, and kidney transplantation on the disparity in patient survival among African American versus non-African American patients with LN-caused ESRD, compared with other causes. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: Using the US Renal Data System database, we identified 12,352 patients with LN-caused ESRD among 1,132,202 patients who initiated maintenance dialysis therapy from January 1, 1995, through December 31, 2006, and were followed up until December 31, 2010. PREDICTORS: Baseline demographics and comorbid conditions, Hispanic ethnicity, socioeconomic factors (employment status, Medicare/Medicaid insurance, and area-level median household income based on zip code as obtained from the 2000 US census), and kidney transplantation as a time-dependent variable. OUTCOME: All-cause mortality. MEASUREMENTS: Multivariable Cox and competing-risk regressions. RESULTS: Mean duration of follow-up in the LN-caused ESRD and other-cause ESRD cohorts were 6.24±4.20 (SD) and 4.06±3.61 years, respectively. 6,106 patients with LN-caused ESRD (49.43%) and 853,762 patients with other-cause ESRD (76.24%) died during the study period (P<0.001). Patients with LN-caused ESRD were significantly younger (mean age, 39.92 years) and more likely women (81.65%) and African American (48.13%) than those with other-cause ESRD. In the fully adjusted multivariable Cox regression model, African American (vs non-African American) patients with LN-caused ESRD had significantly increased risk of death at age 18 to 30 years (adjusted HR, 1.43; 95% CI, 1.24-1.65) and at age 31 to 40 years (adjusted HR, 1.17; 95% CI, 1.02-1.34). Among patients with other-cause ESRD, African Americans were at significantly increased risk at age 18 to 30 years (adjusted HR, 1.17; 95% CI, 1.11-1.22). LIMITATIONS: We used zip code-based median household income as a surrogate for patient income. Residual socioeconomic confounders may exist. CONCLUSIONS: African Americans are at significantly increased risk of death compared with non-African Americans with LN-caused ESRD at age 18 to 40 years, a racial disparity risk that is 10 years longer than that in the general ESRD population. Accounting for area-level median household income and transplantation significantly attenuated the disparity in mortality of African American versus non-African American patients with LN-caused ESRD. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/26002293/Survival_Disparity_of_African_American_Versus_Non_African_American_Patients_With_ESRD_Due_to_SLE_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(15)00641-1 DB - PRIME DP - Unbound Medicine ER -