HHS Public Access Author manuscript Author Manuscript
Circulation. Author manuscript; available in PMC 2016 October 20. Published in final edited form as: Circulation. 2015 October 20; 132(16): 1538–1548. doi:10.1161/CIRCULATIONAHA.114.015124.
Association of Race with Mortality and Cardiovascular Events in a Large Cohort of US Veterans Csaba P. Kovesdy, MD1,2, Keith C. Norris, MD, PhD3, L. Ebony Boulware, MD, MPH4, Jun L. Lu, MD2, Jennie Z. Ma, PhD5, Elani Streja, PhD, MPH6, Miklos Z. Molnar, MD, PhD2, and Kamyar Kalantar-Zadeh, MD, PhD, MPH6 1Nephrology
Author Manuscript
2Division
Section, Memphis VA Medical Center, Memphis, TN
of Nephrology, University of Tennessee Health Science Center, Memphis, TN
3Department
of Medicine, David Geffen School Of Medicine at UCLA, Los Angeles, CA
4Department
of Medicine, Duke University, Durham, NC
5Department
of Public Health Sciences and Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville, VA
6Harold
Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California-Irvine, Orange, CA
Abstract Author Manuscript
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.
Author Manuscript
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/1.73m2 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
Circulation. Author manuscript; available in PMC 2016 October 20. Published in final edited form as: Circulation. 2015 October 20; 132(16): 1538–1548. doi:10.1161/CIRCULATIONAHA.114.015124.
Association of Race with Mortality and Cardiovascular Events in a Large Cohort of US Veterans Csaba P. Kovesdy, MD1,2, Keith C. Norris, MD, PhD3, L. Ebony Boulware, MD, MPH4, Jun L. Lu, MD2, Jennie Z. Ma, PhD5, Elani Streja, PhD, MPH6, Miklos Z. Molnar, MD, PhD2, and Kamyar Kalantar-Zadeh, MD, PhD, MPH6 1Nephrology
Author Manuscript
2Division
Section, Memphis VA Medical Center, Memphis, TN
of Nephrology, University of Tennessee Health Science Center, Memphis, TN
3Department
of Medicine, David Geffen School Of Medicine at UCLA, Los Angeles, CA
4Department
of Medicine, Duke University, Durham, NC
5Department
of Public Health Sciences and Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville, VA
6Harold
Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California-Irvine, Orange, CA
Abstract Author Manuscript
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.
Author Manuscript
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/1.73m2 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
