END-STAGE RENAL-DISEASE IN AFRICAN-AMERICAN AND WHITE MEN - 16-YEAR MRFIT FINDINGS

Objective.-To determine reasons for the 4-fold higher incidence of tre ated end-stage renal disease (ESRD) in African-American men compared w ith white men. Design.-Prospective study. Setting.-Men screened in 197 3 through 1975 for entry into the Multiple Risk Factor Intervention Tr ial (MRFIT). Participants.-A total of 332 544 men (300 645 white, 20 2 22 African American, and 11 677 other ethnic groups) aged 35 to 57 yea rs. Main Outcome Measures.-Incidence of ESRD assessed through 1990 usi ng the Health Care Financing Administration national ESRD treatment re gistry and by surveillance for death from renal disease from data of t he National Death Index and the Social Security Administration. Result s.-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 pers on-years in African-American men, Higher blood pressure and lower soci oeconomic status were associated with higher incidence of ESRD in both ethnic groups, With adjustment for baseline age, systolic blood press ure, number of cigarettes smoked, previous myocardial infarction, diab etes, income, and serum cholesterol level, relative risk of ESRD in Af rican-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 pr essure 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. Conclusio n.-Both higher blood pressure and lower income are associated with a h igher incidence of ESRD in both white and African-American men. Dispar ities in blood pressure and socioeconomic status relate importantly to the excess risk of ESRD in African-American men compared with white m en.