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Association of Race with Mortality and Cardiovascular Events in a Large Cohort of US Veterans

  • Author(s): Kovesdy, CP
  • Norris, KC
  • Ebony Boulware, L
  • Lu, JL
  • Ma, JZ
  • Streja, E
  • Molnar, MZ
  • Kalantar-Zadeh, K
  • et al.
Abstract

© 2015 by the American College of Cardiology Foundation and the American Heart Association, Inc. BACKGROUND—: In the general population African-Americans experience higher mortality than their white peers, attributed, in part, to their lower socio-economic status, reduced access to care and possibly intrinsic biologic factors. A notable exception are patients with kidney disease, among whom African-Americans experience lower mortality. It is unclear if similar differences affecting outcomes exist in patients with no kidney disease but with similar access to health care. METHODS AND RESULTS—: We compared all-cause mortality, incident coronary heart disease (CHD) and incident ischemic stroke using multivariable adjusted Cox models in a nationwide cohort of 547,441 African-American and 2,525,525 white patients with baseline estimated glomerular filtration rate (eGFR) ≥60 ml/min/1.73m receiving care from the US Veterans Health Administration. In parallel analyses we compared outcomes in African-American vs. white individuals in the National Health and Nutrition Examination Survey 1999-2004 (NHANES). After multivariable adjustments in veterans, African-American race was associated with 24% lower all-cause mortality (adjusted hazard ratio (aHR), 95% confidence interval (CI): 0.76, 0.75-0.77, p<0.001) and 37% lower incidence of CHD (aHR, 95%CI: 0.63, 0.62-0.65, p<0.001), but similar incidence of ischemic stroke (aHR, 95%CI: 0.99, 0.97-1.01, p=0.3). African-American race was associated with a 42% higher adjusted mortality among individuals with eGFR≥60 ml/min/1.73m in NHANES (aHR, 95%CI: 1.42 (1.09-1.87)). CONCLUSIONS—: African-American veterans with normal eGFR have lower all-cause mortality and incidence of CHD, and similar incidence of ischemic stroke. These associations are in contrast with the higher mortality experienced by African-American individuals in the general US population.

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