Socioeconomic status and the development of atrial fibrillation in Hispanics, African Americans and non-Hispanic whites

Eric Shulman, Faraj Kargoli, Philip Aagaard, Ethan Hoch, Luigi Di Biase, John Devens Fisher, Jay N. Gross, Soo G. Kim, Kevin J. Ferrick, Andrew K. Krumerman

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Atrial fibrillation (AF) is the most common arrhythmia and is associated with significant morbidity and mortality. Despite having a higher burden of traditional AF risk factors, African American and Hispanic minorities have a lower incidence of AF when compared to non-Hispanic whites, referred to as the "racial paradox." Hypothesis: Lower SES among Hispanics and African Americans may help to explain the lower incidence rates of AF compared to non-Hispanic whites. Methods: An electrocardiogram/electronic medical records database in New York State was interrogated for individuals free of AF for development of subsequent AF from 2000 to 2013. SES was assessed per zip code via a composite of 6 measures Z-scored to the New York State average. SES was reclassified into decile groups. Cox regression analysis controlling for all baseline differences was used to estimate the independent predictive ability of SES for AF. Results: We identified 48631 persons (43% Hispanic, 37% African Americans, and 20% non-Hispanic white; mean age 59 years; mean follow-up of 3.2years) of which 4556 AF cases occurred. Hispanics and African Americans had lower AF risk than whites in all SES deciles (P < 0.001 by log-rank test). Higher SES was borderline associated with lower AF risk (hazard ratio: 0.990, 95% confidence interval: 0.980-1.001, P = 0.061). P trend analysis was not significant by any race/ethnic group by SES deciles for AF. Conclusions: Our study suggests that non-Hispanic whites were at higher risk for AF compared to nonwhites, and this was independent of SES.

Original languageEnglish (US)
JournalClinical Cardiology
DOIs
StateAccepted/In press - 2017

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Hispanic Americans
Social Class
African Americans
Atrial Fibrillation
Electronic Health Records
Incidence
Ethnic Groups
Cardiac Arrhythmias
Electrocardiography
Odds Ratio
Regression Analysis
Databases
Confidence Intervals
Morbidity

Keywords

  • Arrhythmias
  • Atrial Fibrillation
  • Race and Ethnicity
  • Risk Factors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{63a0a8e165554287982bbb617b92e73a,
title = "Socioeconomic status and the development of atrial fibrillation in Hispanics, African Americans and non-Hispanic whites",
abstract = "Background: Atrial fibrillation (AF) is the most common arrhythmia and is associated with significant morbidity and mortality. Despite having a higher burden of traditional AF risk factors, African American and Hispanic minorities have a lower incidence of AF when compared to non-Hispanic whites, referred to as the {"}racial paradox.{"} Hypothesis: Lower SES among Hispanics and African Americans may help to explain the lower incidence rates of AF compared to non-Hispanic whites. Methods: An electrocardiogram/electronic medical records database in New York State was interrogated for individuals free of AF for development of subsequent AF from 2000 to 2013. SES was assessed per zip code via a composite of 6 measures Z-scored to the New York State average. SES was reclassified into decile groups. Cox regression analysis controlling for all baseline differences was used to estimate the independent predictive ability of SES for AF. Results: We identified 48631 persons (43{\%} Hispanic, 37{\%} African Americans, and 20{\%} non-Hispanic white; mean age 59 years; mean follow-up of 3.2years) of which 4556 AF cases occurred. Hispanics and African Americans had lower AF risk than whites in all SES deciles (P < 0.001 by log-rank test). Higher SES was borderline associated with lower AF risk (hazard ratio: 0.990, 95{\%} confidence interval: 0.980-1.001, P = 0.061). P trend analysis was not significant by any race/ethnic group by SES deciles for AF. Conclusions: Our study suggests that non-Hispanic whites were at higher risk for AF compared to nonwhites, and this was independent of SES.",
keywords = "Arrhythmias, Atrial Fibrillation, Race and Ethnicity, Risk Factors",
author = "Eric Shulman and Faraj Kargoli and Philip Aagaard and Ethan Hoch and {Di Biase}, Luigi and Fisher, {John Devens} and Gross, {Jay N.} and Kim, {Soo G.} and Ferrick, {Kevin J.} and Krumerman, {Andrew K.}",
year = "2017",
doi = "10.1002/clc.22732",
language = "English (US)",
journal = "Clinical Cardiology",
issn = "0160-9289",
publisher = "John Wiley and Sons Inc.",

}

TY - JOUR

T1 - Socioeconomic status and the development of atrial fibrillation in Hispanics, African Americans and non-Hispanic whites

AU - Shulman, Eric

AU - Kargoli, Faraj

AU - Aagaard, Philip

AU - Hoch, Ethan

AU - Di Biase, Luigi

AU - Fisher, John Devens

AU - Gross, Jay N.

AU - Kim, Soo G.

AU - Ferrick, Kevin J.

AU - Krumerman, Andrew K.

PY - 2017

Y1 - 2017

N2 - Background: Atrial fibrillation (AF) is the most common arrhythmia and is associated with significant morbidity and mortality. Despite having a higher burden of traditional AF risk factors, African American and Hispanic minorities have a lower incidence of AF when compared to non-Hispanic whites, referred to as the "racial paradox." Hypothesis: Lower SES among Hispanics and African Americans may help to explain the lower incidence rates of AF compared to non-Hispanic whites. Methods: An electrocardiogram/electronic medical records database in New York State was interrogated for individuals free of AF for development of subsequent AF from 2000 to 2013. SES was assessed per zip code via a composite of 6 measures Z-scored to the New York State average. SES was reclassified into decile groups. Cox regression analysis controlling for all baseline differences was used to estimate the independent predictive ability of SES for AF. Results: We identified 48631 persons (43% Hispanic, 37% African Americans, and 20% non-Hispanic white; mean age 59 years; mean follow-up of 3.2years) of which 4556 AF cases occurred. Hispanics and African Americans had lower AF risk than whites in all SES deciles (P < 0.001 by log-rank test). Higher SES was borderline associated with lower AF risk (hazard ratio: 0.990, 95% confidence interval: 0.980-1.001, P = 0.061). P trend analysis was not significant by any race/ethnic group by SES deciles for AF. Conclusions: Our study suggests that non-Hispanic whites were at higher risk for AF compared to nonwhites, and this was independent of SES.

AB - Background: Atrial fibrillation (AF) is the most common arrhythmia and is associated with significant morbidity and mortality. Despite having a higher burden of traditional AF risk factors, African American and Hispanic minorities have a lower incidence of AF when compared to non-Hispanic whites, referred to as the "racial paradox." Hypothesis: Lower SES among Hispanics and African Americans may help to explain the lower incidence rates of AF compared to non-Hispanic whites. Methods: An electrocardiogram/electronic medical records database in New York State was interrogated for individuals free of AF for development of subsequent AF from 2000 to 2013. SES was assessed per zip code via a composite of 6 measures Z-scored to the New York State average. SES was reclassified into decile groups. Cox regression analysis controlling for all baseline differences was used to estimate the independent predictive ability of SES for AF. Results: We identified 48631 persons (43% Hispanic, 37% African Americans, and 20% non-Hispanic white; mean age 59 years; mean follow-up of 3.2years) of which 4556 AF cases occurred. Hispanics and African Americans had lower AF risk than whites in all SES deciles (P < 0.001 by log-rank test). Higher SES was borderline associated with lower AF risk (hazard ratio: 0.990, 95% confidence interval: 0.980-1.001, P = 0.061). P trend analysis was not significant by any race/ethnic group by SES deciles for AF. Conclusions: Our study suggests that non-Hispanic whites were at higher risk for AF compared to nonwhites, and this was independent of SES.

KW - Arrhythmias

KW - Atrial Fibrillation

KW - Race and Ethnicity

KW - Risk Factors

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U2 - 10.1002/clc.22732

DO - 10.1002/clc.22732

M3 - Article

C2 - 28598574

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JO - Clinical Cardiology

JF - Clinical Cardiology

SN - 0160-9289

ER -