Abstract
Survival paradoxes are commonly observed in the literature. This phenomenon describes the association of certain risk factors with negative outcomes in the general population and the opposite effect in certain subpopu-lations and vice versa. Overall, the field is poorly understood. The counter-intuitive findings reported in the literature have contributed to confusion among clinicians regarding the appropriate treatment of conventional risk factors in patients with chronic diseases. Below we review two such paradoxes in kidney and cardiovascular disease epidemiology and discuss possible explanations of these findings.
Highlights
Survival paradoxes are commonly observed in the literature
Survival Advantage Among Black Hemodialysis Patients Despite racial disparities among blacks in socioeconomic position, education, lifestyle factors, comorbid conditions, access to medical care, and utilization of health services, a reverse survival advantage is seen in hemodialysis patients
Risk of death was nearly 45% [Hazard Ratio (HR) = 0.55, 95% Confidence Interval (CI) = 0.44–0.69] lower in black hemodialysis patients compared with white hemodialysis patients after adjusting for factors related to survival in their database [2]
Summary
Survival paradoxes are commonly observed in the literature. This phenomenon describes the association of certain risk factors with negative outcomes in the general population and the opposite effect in certain subpopulations and vice versa. Conventional cardiovascular risk factors such as black race, hypercholesterolemia, hypertension, and obesity are associated with increased survival among hemodialysis patients [1].
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