title: Ethnic Differences in Incidence and Outcomes of Childhood Nephrotic Syndrome.
abstract: Ethnic differences in outcomes among children with nephrotic syndrome are unknown.
  
  
  
  We conducted a longitudinal study at a single regional pediatric center comparing ethnic differences in incidence from 2001 to 2011 census data and longitudinal outcomes, including relapse rates, time to first relapse, frequently relapsing disease, and use of cyclophosphamide. Among 711 children, 24% were European, 33% were South Asian, 10% were East/Southeast Asian, and 33% were of other origins.
  
  
  
  Over 10 years, the overall incidence increased from 1.99/100,000 to 4.71/100,000 among children ages 1-18 years old. In 2011, South Asians had a higher incidence rate ratio of 6.61 (95% confidence interval, 3.16 to 15.1) compared with Europeans. East/Southeast Asians had a similar incidence rate ratio (0.76; 95% confidence interval, 0.13 to 2.94) to Europeans. We determined outcomes in 455 children from the three largest ethnic groups with steroid-sensitive disease over a median of 4 years. South Asian and East/Southeast Asian children had significantly lower odds of frequently relapsing disease at 12 months (South Asian: adjusted odds ratio; 0.55; 95% confidence interval, 0.39 to 0.77; East/Southeast Asian: adjusted odds ratio; 0.42; 95% confidence interval, 0.34 to 0.51), fewer subsequent relapses (South Asian: adjusted odds ratio; 0.64; 95% confidence interval, 0.50 to 0.81; East/Southeast Asian: adjusted odds ratio; 0.47; 95% confidence interval, 0.24 to 0.91), lower risk of a first relapse (South Asian: adjusted hazard ratio, 0.74; 95% confidence interval, 0.67 to 0.83; East/Southeast Asian: adjusted hazard ratio, 0.65; 95% CI, 0.63 to 0.68), and lower use of cyclophosphamide (South Asian: adjusted hazard ratio, 0.82; 95% confidence interval, 0.53 to 1.28; East/Southeast Asian: adjusted hazard ratio, 0.54; 95% confidence interval, 0.41 to 0.71) compared with European children.
  
  
  
  Despite the higher incidence among South Asians, South and East/Southeast Asian children have significantly less complicated clinical outcomes compared with Europeans.
authors.affiliation: Child Health Evaluative Sciences, Research Institute.
authors.forename: Tonny H M
authors.initials: THM
authors.lastname: Banh
authors.affiliation: Child Health Evaluative Sciences, Research Institute.
authors.forename: Neesha
authors.initials: N
authors.lastname: Hussain-Shamsy
authors.affiliation: Child Health Evaluative Sciences, Research Institute.
authors.forename: Viral
authors.initials: V
authors.lastname: Patel
authors.affiliation: Child Health Evaluative Sciences, Research Institute.
authors.forename: Jovanka
authors.initials: J
authors.lastname: Vasilevska-Ristovska
authors.affiliation: Child Health Evaluative Sciences, Research Institute.
authors.forename: Karlota
authors.initials: K
authors.lastname: Borges
authors.affiliation: Child Health Evaluative Sciences, Research Institute.
authors.forename: Cathryn
authors.initials: C
authors.lastname: Sibbald
authors.affiliation: Child Health Evaluative Sciences, Research Institute.
authors.forename: Deborah
authors.initials: D
authors.lastname: Lipszyc
authors.affiliation: Division of Nephrology, and.
authors.forename: Josefina
authors.initials: J
authors.lastname: Brooke
authors.affiliation: Division of Nephrology, and.|University of Toronto, Toronto, Ontario, Canada.
authors.forename: Denis
authors.initials: D
authors.lastname: Geary
authors.affiliation: Division of Nephrology, and.|University of Toronto, Toronto, Ontario, Canada.
authors.forename: Valerie
authors.initials: V
authors.lastname: Langlois
authors.affiliation: Division of Nephrology, and.
authors.forename: Michele
authors.initials: M
authors.lastname: Reddon
authors.affiliation: Division of Nephrology, and.|University of Toronto, Toronto, Ontario, Canada.
authors.forename: Rachel
authors.initials: R
authors.lastname: Pearl
authors.affiliation: Division of Nephrology, and.|University of Toronto, Toronto, Ontario, Canada.
authors.forename: Leo
authors.initials: L
authors.lastname: Levin
authors.affiliation: Division of Nephrology, and.
authors.forename: Monica
authors.initials: M
authors.lastname: Piekut
authors.affiliation: Division of Nephrology, and.|Program in Cell Biology, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.|University of Toronto, Toronto, Ontario, Canada.
authors.forename: Christoph P B
authors.initials: CPB
authors.lastname: Licht
authors.affiliation: Division of Nephrology, and.|University of Toronto, Toronto, Ontario, Canada.
authors.forename: Seetha
authors.initials: S
authors.lastname: Radhakrishnan
authors.affiliation: Division of Nephrology, and.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Aitken-Menezes
authors.affiliation: Division of Nephrology, and.|University of Toronto, Toronto, Ontario, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Harvey
authors.affiliation: Division of Nephrology, and.|University of Toronto, Toronto, Ontario, Canada.
authors.forename: Diane
authors.initials: D
authors.lastname: Hebert
authors.affiliation: Division of Nephrology, and.|University of Toronto, Toronto, Ontario, Canada.
authors.forename: Tino D
authors.initials: TD
authors.lastname: Piscione
authors.affiliation: Child Health Evaluative Sciences, Research Institute.|Division of Nephrology, and.|University of Toronto, Toronto, Ontario, Canada.|University Health Network, Toronto, Ontario, Canada; and.|Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Rulan S
authors.initials: RS
authors.lastname: Parekh
mesh_terms: D001210:Asia, Southeastern / Q000208:ethnology; D002648:Child; D002675:Child, Preschool; D003520:Cyclophosphamide / Q000627:therapeutic use*; D018572:Disease-Free Survival; D004351:Drug Resistance; D005060:Europe / Q000208:ethnology; D005202:Asia, Eastern / Q000208:ethnology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D009404:Nephrotic Syndrome / Q000188:drug therapy* / Q000208:ethnology*; D009864:Ontario / Q000453:epidemiology; D011241:Prednisone / Q000627:therapeutic use*; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D011241:Prednisone
keywords: Asian Continental Ancestry Group; Ethnic Groups; European Continental Ancestry Group; Humans; Incidence; Longitudinal Studies; Recurrence; children; cyclophosphamide; ethnicity; nephrotic syndrome; steroids