Incident Atrial Fibrillation Among American Indians in California
2019; Lippincott Williams & Wilkins; Volume: 140; Issue: 19 Linguagem: Inglês
10.1161/circulationaha.119.042882
ISSN1524-4539
AutoresJosé M. Sánchez, Stacey E. Jolly, Thomas A. Dewland, Zian H. Tseng, Gregory Nah, Eric Vittinghoff, Gregory M. Marcus,
Tópico(s)Cardiac Arrhythmias and Treatments
ResumoHomeCirculationVol. 140, No. 19Incident Atrial Fibrillation Among American Indians in California Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBIncident Atrial Fibrillation Among American Indians in California José M. Sanchez, MD, Stacey E. Jolly, MD, MAS, Thomas A. Dewland, MD, Zian H. Tseng, MD, Gregory Nah, MA, Eric Vittinghoff, PhD and Gregory M. Marcus, MD, MAS José M. SanchezJosé M. Sanchez Section of Cardiac Electrophysiology, Division of Cardiology (J.M.S., Z.H.T., G.N., G.M.M.), University of California, San Francisco. , Stacey E. JollyStacey E. Jolly Department of General Internal Medicine, Cleveland Clinic, OH (S.E.J.). , Thomas A. DewlandThomas A. Dewland Knight Cardiovascular Institute, Oregon Health and Science University, Portland (T.A.D.). , Zian H. TsengZian H. Tseng Section of Cardiac Electrophysiology, Division of Cardiology (J.M.S., Z.H.T., G.N., G.M.M.), University of California, San Francisco. , Gregory NahGregory Nah Section of Cardiac Electrophysiology, Division of Cardiology (J.M.S., Z.H.T., G.N., G.M.M.), University of California, San Francisco. , Eric VittinghoffEric Vittinghoff Department of Epidemiology and Biostatistics (E.V.), University of California, San Francisco. and Gregory M. MarcusGregory M. Marcus Gregory M. Marcus, MD, MAS, 505 Parnassus Avenue, M1180B, San Francisco, CA 94143. Email E-mail Address: [email protected] Section of Cardiac Electrophysiology, Division of Cardiology (J.M.S., Z.H.T., G.N., G.M.M.), University of California, San Francisco. Originally published21 Oct 2019https://doi.org/10.1161/CIRCULATIONAHA.119.042882Circulation. 2019;140:1605–1606Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: October 21, 2019: Ahead of Print Members of the white race have consistently exhibited a higher prevalence and incidence of atrial fibrillation (AF).1 This observation has been referred to as the racial paradox, given that minorities often experience more traditional AF risk factors than whites.2 Although American Indians exhibit high rates of AF risk factors, they have not been included in previous research that has examined the relationship between race and incident AF.We used the Healthcare Cost and Utilization Project (HCUP) California State Databases to identify California residents (≥18 years of age) who received care in an emergency department, inpatient hospital unit, or ambulatory surgery setting between January 1, 2005, and December 31, 2011. Patients entered the cohort at first healthcare encounter, were followed up prospectively, and were censored on diagnosis of AF, time of inpatient death, or end of the study period. Certification to use deidentified HCUP data was obtained from the University of California, San Francisco, Institutional Review Board.Among 16 442 944 patients, 101 848 (0.6%) were American Indian, 9 409 152 (57.2%) were white, 1 309 520 (8.0%) were black, 4 202 316 (25.6%) were Hispanic, and 1 416 481 (8.6%) were Asian. Of the American Indian cohort, 1501 (1.5%) were excluded because of prevalent AF, and 309 255 (3.3%) whites, 15 418 (1.2%) blacks, 30 713 (2.2%) Asians, and 43 080 (1.0%) Hispanics were excluded because of prevalent AF. There were 344 469 incident AF episodes over a median follow-up of 4.1 years (interquartile range, 2.4–5.2 years). The overall incidence of AF in American Indians was 7.49 per 1000 person-years versus 6.89 per 1000 person-years in the rest of the cohort (P<0.0001). After adjustment for age, sex, income level, insurance payer, hypertension, diabetes mellitus, coronary artery disease, heart failure, valvular disease, chronic kidney disease, smoking, sleep apnea, pulmonary disease, alcohol use, and number of healthcare encounters, the risk of AF in American Indians was significantly higher compared with each racial and ethnic group, including whites (Figure). Similar results were obtained in sensitivity analyses when restricted to individuals with encounters in only emergency departments or inpatient hospital units, and in individuals ≥35 years of age with at least 2 encounters. The role of various AF risk factors on the risk of incident AF was then explored in interaction analyses, demonstrating that the relatively higher risk of AF among American Indians was attenuated by the presence of diabetes mellitus and chronic kidney disease.Download figureDownload PowerPointFigure. Adjusted Kaplan-Meier curves for incident atrial fibrillation (AF) in American Indian, white, black, Hispanic, and Asian patients. The curves are adjusted for age, sex, income level, insurance payer, hypertension, diabetes mellitus, coronary artery disease, heart failure, valvular disease, chronic kidney disease, smoking, sleep apnea, pulmonary disease, alcohol use, and number of healthcare encounters. *Comparison between American Indians and each individual race and ethnicity, P<0.0001.In this longitudinal analysis, American Indians exhibited a higher risk of incident AF compared with each other's race and ethnicity. To the best of our knowledge, only 1 previous study has examined American Indians and AF in comparison with other groups.3 In that cross-sectional study, American Indians had a high prevalence of AF compared with blacks, Hispanics, Asians, and Pacific Islanders, with American Indians and whites exhibiting the most similar findings. However, that was a cross-sectional rather than a longitudinal study limited to a population of American male veterans, potentially representing a group distinct from the general population.In our interaction analyses, the risk of AF attributed to the American Indian race was attenuated by the presence of diabetes mellitus or chronic kidney disease. This may suggest that the presence of these 2 processes contributes some pathophysiology related to AF risk that may be similar to the heightened risk inherent among American Indians. It is also important to note that there was no evidence of any other statistically significant interactions despite the inclusion of millions of patients.We performed sensitivity analyses to test and consequently validate our findings. To avoid introduction of ascertainment bias, we performed an analysis in patients ≥35 years of age with at least 2 encounters. A separate sensitivity analysis also excluded the Ambulatory Surgery Database, which may disproportionately represent different populations undergoing elective procedures. Our observations were not meaningfully changed by either analysis.Whereas the broad inclusion criteria, a common study cohort, a large sample size, and sensitivity analyses all support the validity of our results, it is important to acknowledge several limitations. HCUP relies on physician coding practices. However, using these methods, in particular the HCUP database, has proven to be an effective approach for large population studies.4 Another limitation is the reliance on self-report for race and ethnicity, which may result in misclassification of American Indians in administrative patient data.5 Race was coded as a mutually exclusive category, prohibiting analyses related to multiracial individuals. Furthermore, the absence of outpatient encounters in HCUP may introduce some selection bias. Last, because this was an observational study, these results should not be interpreted as evidence of causal effects.In conclusion, we observed that American Indians had a higher risk of AF compared with all other racial and ethnic group. The heightened risk of AF in American Indians persisted after multivariable adjustment for known conventional confounders and mediators, suggesting that an unidentified characteristic, including possible genetic or environmental factors, may be responsible.Sources of FundingThe HCUP database is supported by the Agency for Healthcare Research and Quality.DisclosuresDr Marcus has received research support from Jawbone, Medtronic, Eight, and Baylis and is a consultant for and holds equity in InCarda. The other authors report no conflicts.Footnoteshttps://www.ahajournals.org/journal/circData Sharing: Interested investigators can contact the California HCUP for data requests.Gregory M. Marcus, MD, MAS, 505 Parnassus Avenue, M1180B, San Francisco, CA 94143. Email greg.[email protected]eduReferences1. Dewland TA, Olgin JE, Vittinghoff E, Marcus GM. Incident atrial fibrillation among Asians, Hispanics, blacks, and whites.Circulation. 2013; 128:2470–2477. doi: 10.1161/CIRCULATIONAHA.113.002449LinkGoogle Scholar2. Ugowe FE, Jackson LR, Thomas KL. Racial and ethnic differences in the prevalence, management, and outcomes in patients with atrial fibrillation: a systematic review.Heart Rhythm. 2018; 15:1337–1345. doi: 10.1016/j.hrthm.2018.05.019CrossrefMedlineGoogle Scholar3. Borzecki AM, Bridgers DK, Liebschutz JM, Kader B, Kazis LE, Berlowitz DR. Racial differences in the prevalence of atrial fibrillation among males.J Natl Med Assoc. 2008; 100:237–245. doi: 10.1016/s0027-9684(15)31212-8CrossrefMedlineGoogle Scholar4. Gialdini G, Nearing K, Bhave PD, Bonuccelli U, Iadecola C, Healey JS, Kamel H. Perioperative atrial fibrillation and the long-term risk of ischemic stroke.JAMA. 2014; 312:616–622. doi: 10.1001/jama.2014.9143CrossrefMedlineGoogle Scholar5. Rhoades DA. Racial misclassification and disparities in cardiovascular disease among American Indians and Alaska Natives.Circulation. 2005; 111:1250–1256. doi: 10.1161/01.CIR.0000157735.25005.3FLinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited ByTsao C, Aday A, Almarzooq Z, Anderson C, Arora P, Avery C, Baker-Smith C, Beaton A, Boehme A, Buxton A, Commodore-Mensah Y, Elkind M, Evenson K, Eze-Nliam C, Fugar S, Generoso G, Heard D, Hiremath S, Ho J, Kalani R, Kazi D, Ko D, Levine D, Liu J, Ma J, Magnani J, Michos E, Mussolino M, Navaneethan S, Parikh N, Poudel R, Rezk-Hanna M, Roth G, Shah N, St-Onge M, Thacker E, Virani S, Voeks J, Wang N, Wong N, Wong S, Yaffe K and Martin S (2023) Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association, Circulation, 147:8, (e93-e621), Online publication date: 21-Feb-2023. Albertsen N, Riahi S, Pedersen M, Skovgaard N and Andersen S (2022) The prevalence of atrial fibrillation in Greenland: a register-based cross-sectional study based on disease classifications and prescriptions of oral anticoagulants, International Journal of Circumpolar Health, 10.1080/22423982.2022.2030522, 81:1, Online publication date: 31-Dec-2022. Sanchez J and Marcus G (2022) American Indians and atrial fibrillation, Heart Rhythm O2, 10.1016/j.hroo.2022.08.010, 3:6, (760-765), Online publication date: 1-Dec-2022. Ariss R, Minhas A, Lang J, Ramanathan P, Khan S, Kassi M, Warraich H, Kolte D, Alkhouli M and Nazir S (2022) Demographic and Regional Trends in Stroke‐Related Mortality in Young Adults in the United States, 1999 to 2019, Journal of the American Heart Association, 11:18, Online publication date: 20-Sep-2022.Tsao C, Aday A, Almarzooq Z, Alonso A, Beaton A, Bittencourt M, Boehme A, Buxton A, Carson A, Commodore-Mensah Y, Elkind M, Evenson K, Eze-Nliam C, Ferguson J, Generoso G, Ho J, Kalani R, Khan S, Kissela B, Knutson K, Levine D, Lewis T, Liu J, Loop M, Ma J, Mussolino M, Navaneethan S, Perak A, Poudel R, Rezk-Hanna M, Roth G, Schroeder E, Shah S, Thacker E, VanWagner L, Virani S, Voecks J, Wang N, Yaffe K and Martin S (2022) Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association, Circulation, 145:8, (e153-e639), Online publication date: 22-Feb-2022. Norby F, Benjamin E, Alonso A and Chugh S (2021) Racial and Ethnic Considerations in Patients With Atrial Fibrillation, Journal of the American College of Cardiology, 10.1016/j.jacc.2021.04.110, 78:25, (2563-2572), Online publication date: 1-Dec-2021. Essien U, Kornej J, Johnson A, Schulson L, Benjamin E and Magnani J (2021) Social determinants of atrial fibrillation, Nature Reviews Cardiology, 10.1038/s41569-021-00561-0, 18:11, (763-773), Online publication date: 1-Nov-2021. Stavrakis S, Elkholey K, Lofgren M, Asad Z, Stephens L and Freedman B (2021) Screening for Atrial Fibrillation in American Indian Adults in a Tribal Primary Care Clinic, Journal of the American Heart Association, 10:9, Online publication date: 4-May-2021. Rukovets O (2021) What to Do About the Disproportionately Increased Risk of Non-Hemorrhagic Stroke in Native Americans, Neurology Today, 10.1097/01.NT.0000749828.49740.fe, 21:8, (20-22), Online publication date: 15-Apr-2021. Sanchez J, Jolly S, Dewland T, Tseng Z, Nah G, Vittinghoff E and Marcus G (2021) Incident Strokes Among American Indian Individuals With Atrial Fibrillation, Journal of the American Heart Association, 10:6, Online publication date: 16-Mar-2021.Virani S, Alonso A, Aparicio H, Benjamin E, Bittencourt M, Callaway C, Carson A, Chamberlain A, Cheng S, Delling F, Elkind M, Evenson K, Ferguson J, Gupta D, Khan S, Kissela B, Knutson K, Lee C, Lewis T, Liu J, Loop M, Lutsey P, Ma J, Mackey J, Martin S, Matchar D, Mussolino M, Navaneethan S, Perak A, Roth G, Samad Z, Satou G, Schroeder E, Shah S, Shay C, Stokes A, VanWagner L, Wang N and Tsao C (2021) Heart Disease and Stroke Statistics—2021 Update, Circulation, 143:8, (e254-e743), Online publication date: 23-Feb-2021. Rowan C, Eskander M, Seabright E, Rodriguez D, Linares E, Gutierrez R, Adrian J, Cummings D, Beheim B, Tolstrup K, Achrekar A, Kraft T, Michalik D, Miyamoto M, Allam A, Wann L, Narula J, Trumble B, Stieglitz J, Thompson R, Thomas G, Kaplan H and Gurven M (2021) Very Low Prevalence and Incidence of Atrial Fibrillation among Bolivian Forager-Farmers, Annals of Global Health, 10.5334/aogh.3252, 87:1, (18) Ferdinand K, Ali A and Echols M (2021) Racial/Ethnic Considerations in the Prevention of Cardiovascular Disease ASPC Manual of Preventive Cardiology, 10.1007/978-3-030-56279-3_20, (463-487), . November 5, 2019Vol 140, Issue 19 Advertisement Article InformationMetrics © 2019 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.119.042882PMID: 31630530 Originally publishedOctober 21, 2019 KeywordsIndians, North Americanatrial fibrillationCaliforniaPDF download Advertisement SubjectsArrhythmiasAtrial FibrillationEpidemiologyRisk Factors
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