Showing papers by "James D. Neaton published in 1997"

End-stage Renal Disease in African-American and White Men: 16-Year MRFIT Findings

Abstract: 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.

Risk of End-stage Renal Disease in Diabetes Mellitus: A Prospective Cohort Study of Men Screened for MRFIT

Abstract: Context. —Diabetes is a frequent cause of end-stage renal disease (ESRD). However, the degree of risk is uncertain. Objective. —To determine the relative risk (RR) of ESRD related to diabetes in the United States. Design. —Nonconcurrent prospective cohort study. Participants. —A total of 332 544 men aged 35 to 57 years from 18 US cities screened in 1973 to 1975 for participation in the Multiple Risk Factor Intervention Trial (MRFIT). Main Exposure. —Diabetes mellitus defined by self-reported use of medication for diabetes at baseline. Main Outcome. —Incident ESRD through 1990 assessed from a national ESRD registry and by surveillance for death from renal disease. Results. —Over an average follow-up of 16 years, there were 136 cases of ESRD in 5147 diabetic men and 678 cases in 327 397 nondiabetic men. Age-adjusted incidence of all-cause ESRD in the diabetic men was 199.8 per 100 000 person-years compared with 13.7 per 100 000 person years in their nondiabetic counterparts (RR, 12.7; 95% confidence interval [Cl], 10.5-15.4). Diabetic men were also at higher risk for ESRD ascribed to causes other than diabetes (RR=4.3; 95% Cl, 3.2-5.9). With simultaneous adjustment for age, ethnicity, income, blood pressure, serum cholesterol level, and history of myocardial infarction, diabetic men remained at higher risk for all-cause ESRD (RR, 9.0; 95% Cl, 7.4-11.0), ESRD ascribed to diabetes (RR, 92.3; 95% Cl, 64.6-131.9), and ESRD ascribed to nondiabetic causes (RR, 3.0; 95% Cl, 2.2-4.1). Conclusions. —Diabetes mellitus is a strong independent risk factor for ESRD, even for ESRD ascribed to causes other than diabetes. Improvements in the prevention and control of diabetes should produce substantial reductions in ESRD incidence.

Predictors of mortality from kidney cancer in 332,547 men screened for the Multiple Risk Factor Intervention Trial.

Abstract: BACKGROUND The authors examined predictors of mortality from kidney cancer in 332,547 men who were screened as part of the Multiple Risk Factor Intervention Trial. METHODS The vital status of each member of this cohort was ascertained through 1990. Death certificates were obtained from state health departments and coded by a trained nosologist. Three hundred ninety-eight deaths due to kidney cancer occurred among the cohort of 332,547 men after an average of 16 years of follow-up. The authors used the Cox proportional hazards model to study the joint associations of age, race, income, blood pressure, cigarette smoking, and use of medication for diabetes with risk of death from kidney cancer. RESULTS The authors observed independent associations with age, cigarette smoking status (relative risk[RR] = 2.02; 95% confidence interval [CI], 1.65-2.48), and systolic blood pressure (relative risk [RR] = 1.12 for systolic blood pressure level 10 millimeters of mercury higher; 95% CI, 1.06-1.18).The authors obtained similar results when deaths that occurred during the first 5 years were excluded. CONCLUSIONS These findings add to the increasing body of evidence that cigarette smoking and blood pressure level are modifiable risk factors for kidney cancer in men. Cancer 1997; 79:2171-7. © 1997 American Cancer Society.