TY - JOUR
T1 - Genetic Admixture and Survival in Diverse Populations with Pulmonary Arterial Hypertension
AU - Karnes, Jason H.
AU - Wiener, Howard W.
AU - Schwantes-An, Tae Hwi
AU - Natarajan, Balaji
AU - Sweatt, Andrew J.
AU - Chaturvedi, Abhishek
AU - Arora, Amit
AU - Batai, Ken
AU - Nair, Vineet
AU - Steiner, Heidi E.
AU - Giles, Jason B.
AU - Yu, Jeffrey
AU - Hosseini, Maryam
AU - Pauciulo, Michael W.
AU - Lutz, Katie A.
AU - Coleman, Anna W.
AU - Feldman, Jeremy
AU - Vanderpool, Rebecca
AU - Tang, Haiyang
AU - Garcia, Joe G.N.
AU - Yuan, Jason X.J.
AU - Kittles, Rick
AU - De Jesus Perez, Vinicio
AU - Zamanian, Roham T.
AU - Rischard, Franz
AU - Tiwari, Hemant K.
AU - Nichols, William C.
AU - Benza, Raymond L.
AU - Desai, Ankit A.
N1 - Publisher Copyright: © 2020 American Thoracic Society. All rights reserved.
PY - 2020/6/1
Y1 - 2020/6/1
N2 - Rationale: Limited information is available on racial/ ethnic differences in pulmonary arterial hypertension (PAH). Objectives: Determine effects of race/ethnicity and ancestry on mortality and disease outcomes in diverse patients with PAH. Methods: Patients with Group 1 PAH were included from two national registries with genome-wide data and two local cohorts, and further incorporated in a global meta-Analysis. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for transplant-free, all-cause mortality in Hispanic patients with non-Hispanic white (NHW) patients as the reference group. Odds ratios (ORs) for inpatient-specific mortality in patients with PAH were also calculated for race/ethnic groups from an additional National Inpatient Sample dataset not included in the meta-Analysis. MeasurementsandMainResults: After covariate adjustment, selfreported Hispanic patients (n = 290) exhibited significantly reduced mortality versus NHWpatients (n = 1,970) after global meta-Analysis (HR, 0.60 [95% CI, 0.41 0.87]; P=0.008). Although not significant, increasing Native American genetic ancestry appeared to account for part of the observed mortality benefit (HR, 0.48 [95% CI, 0.23 1.01]; P = 0.053) in the two national registries. Finally, in the National Inpatient Sample, an inpatient mortality benefit was also observed for Hispanic patients (n = 1,524) versus NHWpatients (n=8,829;OR, 0.65 [95%CI, 0.50 0.84];P = 0.001).Aninpatientmortality benefitwas observed for Native American patients (n = 185; OR, 0.38 [95% CI, 0.15 0.93]; P=0.034). Conclusions: This study demonstrates a reproducible survival benefit for Hispanic patients with Group 1 PAH in multiple clinical settings. Our results implicate contributions of genetic ancestry to differential survival in PAH.
AB - Rationale: Limited information is available on racial/ ethnic differences in pulmonary arterial hypertension (PAH). Objectives: Determine effects of race/ethnicity and ancestry on mortality and disease outcomes in diverse patients with PAH. Methods: Patients with Group 1 PAH were included from two national registries with genome-wide data and two local cohorts, and further incorporated in a global meta-Analysis. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for transplant-free, all-cause mortality in Hispanic patients with non-Hispanic white (NHW) patients as the reference group. Odds ratios (ORs) for inpatient-specific mortality in patients with PAH were also calculated for race/ethnic groups from an additional National Inpatient Sample dataset not included in the meta-Analysis. MeasurementsandMainResults: After covariate adjustment, selfreported Hispanic patients (n = 290) exhibited significantly reduced mortality versus NHWpatients (n = 1,970) after global meta-Analysis (HR, 0.60 [95% CI, 0.41 0.87]; P=0.008). Although not significant, increasing Native American genetic ancestry appeared to account for part of the observed mortality benefit (HR, 0.48 [95% CI, 0.23 1.01]; P = 0.053) in the two national registries. Finally, in the National Inpatient Sample, an inpatient mortality benefit was also observed for Hispanic patients (n = 1,524) versus NHWpatients (n=8,829;OR, 0.65 [95%CI, 0.50 0.84];P = 0.001).Aninpatientmortality benefitwas observed for Native American patients (n = 185; OR, 0.38 [95% CI, 0.15 0.93]; P=0.034). Conclusions: This study demonstrates a reproducible survival benefit for Hispanic patients with Group 1 PAH in multiple clinical settings. Our results implicate contributions of genetic ancestry to differential survival in PAH.
KW - Hispanic American
KW - Native American
KW - health disparities
KW - pulmonary arterial hypertension
KW - survival
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U2 - 10.1164/rccm.201907-1447OC
DO - 10.1164/rccm.201907-1447OC
M3 - Article
C2 - 31916850
SN - 1073-449X
VL - 201
SP - 1407
EP - 1415
JO - American journal of respiratory and critical care medicine
JF - American journal of respiratory and critical care medicine
IS - 11
ER -