Racial differences in the competing risks of mortality and ESRD after acute myocardial infarction
Department of Quantitative Health Sciences
Medical Subject Headings
*African Americans; Aged; *European Continental Ancestry Group; Female; Follow-Up Studies; Glomerular Filtration Rate; Humans; Kidney Failure, Chronic; Male; Myocardial Infarction; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk Factors; Survival Rate; Time Factors; United States
Bioinformatics | Biostatistics | Epidemiology | Health Services Research
BACKGROUND: The prevalence of earlier stage chronic kidney disease is lower for African Americans than whites in the United States. This is counterintuitive given the known 4-fold greater incidence of end-stage renal disease (ESRD) in African Americans. We describe racial differences in the rate of progression to ESRD and address the competing risk of mortality.
STUDY DESIGN: Retrospective analysis of Cooperative Cardiovascular Project data.
SETTING and PARTICIPANTS: 127,736 Medicare beneficiaries 65 years and older admitted to 4,545 hospitals with acute myocardial infarction between February 1994 and June 1995, with follow-up data for ESRD and mortality through June 2004.
PREDICTORS: African American versus white race, estimated glomerular filtration rate (eGFR), and their interaction; other characteristics at hospital admission.
OUTCOMES and MEASUREMENTS: Time to ESRD using Cox proportional hazards models.
RESULTS: Mean age was 77.1 years, with 8,278 African Americans (6.5%) and 49.9% women. Mean baseline eGFRs were 61.4 +/- 31.4 and 57.0 +/- 25.6 mL/min/1.73 m(2) (P < 0.001) for African Americans and whites, respectively. Of 2,161 patients (1.7%) progressing to ESRD (incidence, 3.75/1,000 person-years), 14.9% were African American. The adjusted hazard ratio for ESRD (African Americans versus whites) was 1.90 (95% confidence interval, 1.78 to 2.03); African Americans were at significantly increased risk of incident ESRD at each baseline eGFR stage (P for interaction < 0.001). Racial differences in incident ESRD were not accounted for by differences in mortality.
LIMITATIONS: Retrospective analysis, residual bias from unmeasured factors, baseline eGFR determined from serum creatinine levels at the time of acute hospitalization.
CONCLUSIONS: Within a nationally representative sample of Medicare patients with acute myocardial infarction, African Americans had an increased 10-year risk of ESRD regardless of baseline kidney function that was not accounted for by differences in pre-ESRD mortality.
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Citation: Am J Kidney Dis. 2008 Aug;52(2):251-61. Epub 2008 May 12. Link to article on publisher's site
Newsome, Britt B.; McClellan, William M.; Allison, Jeroan J.; Eggers, Paul W.; Chen, Shu-Cheng; Collins, Allan J.; Kiefe, Catarina I.; Coffey, Christopher S.; and Warnock, David G., "Racial differences in the competing risks of mortality and ESRD after acute myocardial infarction" (2008). Quantitative Health Sciences Publications and Presentations. 31.