End-stage Renal Disease in African-American and... : JAMA: The Journal of the American Medical Association (original) (raw)

16-Year MRFIT Findings

Michael J. Klag
Paul K. Whelton
Bryan L. Randall
James D. Neaton
Frederick L. Brancati
Jeremiah Stamler

JAMA: The Journal of the American Medical Association

277

(

)

1293

1298

April 23/30, 1997

Objective

To determine reasons for the 4-fold higher incidence of treated end-stage renal disease (ESRD) in African-American men compared with white men.

Design

Prospective study.

Setting

Men screened in 1973 through 1975 for entry into the Multiple Risk Factor Intervention Trial (MRFIT).

Participants

A total of 332 544 men (300 645 white, 20 222 African American, and 11 677 other ethnic groups) aged 35 to 57 years.

Main Outcome Measures

Incidence of ESRD assessed through 1990 using the Health Care Financing Administration national ESRD treatment registry and by surveillance for death from renal disease from data of the National Death Index and the Social Security Administration.

Results

Over a mean follow-up of 16 years, age-adjusted ESRD incidence was 13.90 per 100 000 person-years in white men and 44.22 per 100 000 person-years in African-American men. Higher blood pressure and lower socioeconomic status were associated with higher incidence of ESRD in both ethnic groups. With adjustment for baseline age, systolic blood pressure, number of cigarettes smoked, previous myocardial infarction, diabetes, income, and serum cholesterol level, relative risk of ESRD in African-American men compared with white men was reduced from 3.20 to 1.87 (95% confidence interval, 1.47-2.39). Both higher systolic blood pressure and lower income in African-American men as compared with white men were particularly related to this reduced relative risk. Results were similar when hypertensive ESRD was used as the outcome.

Conclusion

Both higher blood pressure and lower income are associated with a higher incidence of ESRD in both white and African-American men. Disparities in blood pressure and socioeconomic status relate importantly to the excess risk of ESRD in African-American men compared with white men.

JAMA.1997;277:1293-1298