Supplementary Material for: End-Stage Kidney Diseases in Immigrant Groups: A Nationwide Cohort Study in Sweden

Background: Our aim was to study the association between the country of birth and incident end-stage kidney disease (ESKD) in several immigrant groups in Sweden, using individuals born in Sweden or with Swedish-born parents as referents. Methods: A cohort study of first- and second-generation immigrants residing in Sweden between January 1, 1998 and December 31, 2012 was performed. Outcomes were defined as having at least one registered diagnosis of ESKD in the National Patient Register. The incidence of ESKD in different immigrant groups was used in the Cox regression models to estimate hazard ratios (HRs) and 95% CIs. All models were stratified by sex and adjusted for age, geographical residence, educational level, marital status, and neighbourhood socioeconomic status. Results: Compared to their referents, higher incidence rates and HRs of ESKD (HR; 95% CI) were observed in general among foreign-born men (1.10; 1.04–1.16) and women (1.12; 1.04–1.21) but not among second-generation immigrants (persons born in Sweden with foreign-born parents). A particularly high incidence was noted among men and women from East-European countries, as well as from non-European regions. A lower incidence of ESKD was noted among men from Finland. Conclusions: We observed substantial differences in incidence of ESKD between immigrant groups and the Swedish-born population, which may be clinically relevant when monitoring preventive measures in patient subgroups with a higher risk of deteriorating kidney disease, and suggest higher attention to hypertension and diabetes control in immigrants. Mechanisms attributable to the migration process or ethnic differences may lead to an increased risk of ESKD.背景：本研究旨在以瑞典本土出生或父母均为瑞典籍的个体作为参照组，探讨瑞典境内多个人群移民群体的出生国家与新发终末期肾病（end-stage kidney disease, ESKD）之间的关联。 方法：本研究开展了一项队列研究，纳入1998年1月1日至2012年12月31日期间居住在瑞典的第一代及第二代移民人群。结局定义为在国家患者登记系统中至少有1次终末期肾病的注册诊断。采用不同移民群体的ESKD发病率构建Cox回归模型，以估计风险比（hazard ratios, HRs）及95%置信区间（95% CIs）。所有模型均按性别进行分层，并对年龄、居住地、教育水平、婚姻状况及社区社会经济地位进行校正。 结果：与参照组相比，整体而言外国出生的男性（HR; 95% CI：1.10; 1.04–1.16）与女性（1.12; 1.04–1.21）的ESKD发病率及风险比均更高，但第二代移民（即瑞典本土出生但父母为外籍的个体）未观察到该现象。来自东欧国家及非欧洲地区的男性与女性群体，其ESKD发病率尤其高。而芬兰籍男性的ESKD发病率则相对较低。 结论：本研究发现移民群体与瑞典本土人群的ESKD发病率存在显著差异，该结果对于监测肾功能恶化高风险患者亚群的预防措施具有临床参考价值，同时提示需对移民群体的高血压与糖尿病管控给予更多关注。移民过程相关机制或种族差异或可导致ESKD风险升高。