背景:与非西班牙裔白人群体相比,西班牙裔个体肾衰竭的风险较高,但活体供体移植和家庭透析的发生率较低。然而,如何家庭透析,死亡率,并且移植在西班牙裔社区内根据患者的起源而有所不同,目前尚不清楚。
方法:我们从美国肾脏数据系统确定了2009年至2017年开始透析的成年西班牙裔患者。主要暴露在原籍国家或地区(美国,墨西哥,美国-波多黎各,和其他国家)。我们使用逻辑回归来估计开始家庭透析的几率差异,并使用竞争风险模型来估计死亡率和肾移植的子分布风险比(SHR)。
结果:在137,039名患者中,44.4%出生在美国,30.9%来自墨西哥,12.9%来自美国波多黎各,11.8%来自其他拉丁美洲国家。家庭透析率低于美国出生的患者,但在调整人口统计学指标后没有显着差异。medical,社会经济,和设施层面的因素。美国-波多黎各人的调整后死亡风险更高(SHR,1.04;95%置信区间[CI],1.01至1.08),墨西哥较低(SHR,0.80;95CI,0.78至0.81)和其他国家(SHR,0.83;95%CI,0.81至0.86)与美国出生的患者相比。墨西哥或美国-波多黎各患者的移植率与美国出生的患者相似,但其他国家的移植率较高(SHR,1.22;95%CI,1.15至1.30)。
结论:来自不同来源的西班牙裔人的家庭透析调整率相似,但死亡率和肾移植调整率不同。需要进一步的研究来了解这些观察到的结果差异的潜在机制。
Hispanic patients are known to have a higher risk of kidney failure and lower rates of home dialysis use and kidney transplantation than non-Hispanic White patients. However, it is unknown whether these outcomes differ within the Hispanic community, which is heterogeneous in its members\' places of origins. Using United States Renal Data System data, the authors found similar adjusted rates of home dialysis use for patients originating from places outside the United States and US-born Hispanic patients, whereas the adjusted risk of mortality and likelihood of transplantation differed depending on place (country or territory) of origin. Understanding the heterogeneity in kidney disease outcomes and treatment within the Hispanic community is crucial in designing interventions and implementation strategies to ensure that Hispanic individuals with kidney failure have equitable access to care.
Compared with non-Hispanic White groups, Hispanic individuals have a higher risk of kidney failure yet lower rates of living donor transplantation and home dialysis. However, how home dialysis, mortality, and transplantation vary within the Hispanic community depending on patients\' place of origin is unclear.
We identified adult Hispanic patients from the United States Renal Data System who initiated dialysis in 2009-2017. Primary exposure was country or territory of origin (the United States, Mexico, US-Puerto Rico, and other countries). We used logistic regression to estimate differences in odds of initiating home dialysis and competing risk models to estimate subdistribution hazard ratios (SHR) of mortality and kidney transplantation.
Of 137,039 patients, 44.4% were US-born, 30.9% were from Mexico, 12.9% were from US-Puerto Rico, and 11.8% were from other countries. Home dialysis rates were higher among US-born patients, but not significantly different after adjusting for demographic, medical, socioeconomic, and facility-level factors. Adjusted mortality risk was higher for individuals from US-Puerto Rico (SHR, 1.04; 95% confidence interval [CI], 1.01 to 1.08) and lower for Mexico (SHR, 0.80; 95% CI, 0.78 to 0.81) and other countries (SHR, 0.83; 95% CI, 0.81 to 0.86) compared with US-born patients. The adjusted rate of transplantation for Mexican or US-Puerto Rican patients was similar to that of US-born patients but higher for those from other countries (SHR, 1.22; 95% CI, 1.15 to 1.30).
Hispanic people from different places of origin have similar adjusted rates of home dialysis but different adjusted rates of mortality and kidney transplantation. Further research is needed to understand the mechanisms underlying these observed differences in outcomes.