Race and Socioeconomic Status Regulate Lifetime Risk of Atrial Fibrillation.
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ABSTRACT:
SUBMITTER: McCauley MD
PROVIDER: S-EPMC6061964 | biostudies-literature | 2018 Jul
REPOSITORIES: biostudies-literature
Publications
Race and Socioeconomic Status Regulate Lifetime Risk of Atrial Fibrillation.
McCauley Mark D MD Darbar Dawood D
Circulation. Arrhythmia and electrophysiology 20180701 7
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Project description:BackgroundLimited information exists on the lifetime risk of atrial fibrillation (AF) in African Americans and by socioeconomic status.MethodsWe studied 15 343 participants without AF at baseline from the ARIC (Atherosclerosis Risk in Communities) cohort recruited in 1987 to 1989 from 4 communities in the United States when they were 45 to 64 years of age. Participants have been followed through 2014. Incidence rates of AF were calculated dividing the number of new cases by person-years of follow-up. Lifetime risk of AF was estimated by a modified Kaplan-Meier method considering death as a competing risk. Participants' family income and education were obtained at baseline.ResultsWe identified 2760 AF cases during a mean follow-up of 21 years. Lifetime risk of AF was 36% (95% confidence interval, 32%-38%) in white men, 30% (95% confidence interval, 26%-32%) in white women, 21% (95% confidence interval, 13%-24%) in African American men, and 22% (95% confidence interval, 16%-25%) in African American women. Regardless of race and sex, incidence rates of AF decreased from the lowest to the highest categories of income and education. In contrast, lifetime risk of AF increased in individuals with higher income and education in most sex-race groups. Cumulative incidence of AF was lower in those with higher income and education compared with their low socioeconomic status counterparts through earlier life but was reversed after age 80.ConclusionsLifetime risk of AF in the ARIC cohort was ≈1 in 3 among whites and 1 in 5 among African Americans. Socioeconomic status was inversely associated with cumulative incidence of AF before the last decades of life.
| S-EPMC6053683 | biostudies-literature
Project description:ObjectiveTo determine the association between neighborhood socioeconomic status (NSES) and cardio-metabolic risk and whether this relationship differs by race/ethnicity.MethodsParticipants in the Multi-Ethnic Study of Atherosclerosis (n = 5750), ages 45-84 years, from 6 US counties, including 5 examinations from 2000 to 2012. We calculated a modified allostatic load (AL) index, indicating cardio-metabolic risk. NSES score included census-derived measures at census tract of residence. Mixed effects growth curve models were used to assess linear and non-linear associations between NSES and AL at baseline and over time.ResultsHigher NSES was associated with lower AL across race/ethnic groups; considering NSES quintiles, significant associations were found only for the highest NSES quintiles (difference of -0.86 and -1.15 for white and Hispanic participants) vs. the lowest. We found no significant association between NSES and change in AL over time.DiscussionOur findings suggest that the relationship between NSES and AL reflects the health benefits of living in the most advantaged neighborhoods.Public health implicationsUnderstanding the impact of higher NSES on health effects may help identify interventions to effectively target high risk neighborhoods.
| S-EPMC7397689 | biostudies-literature
Project description:BackgroundThe long-term probability of developing atrial fibrillation (AF) considering genetic predisposition and clinical risk factor burden is unknown.MethodsWe estimated the lifetime risk of AF in individuals from the community-based Framingham Heart Study. Polygenic risk for AF was derived using a score of ≈1000 AF-associated single-nucleotide polymorphisms. Clinical risk factor burden was calculated for each individual using a validated risk score for incident AF comprised of height, weight, systolic and diastolic blood pressure, current smoking status, antihypertensive medication use, diabetes mellitus, history of myocardial infarction, and history of heart failure. We estimated the lifetime risk of AF within tertiles of polygenic and clinical risk.ResultsAmong 4606 participants without AF at 55 years of age, 580 developed incident AF (median follow-up, 9.4 years; 25th-75th percentile, 4.4-14.3 years). The lifetime risk of AF >55 years of age was 37.1% and was substantially influenced by both polygenic and clinical risk factor burden. Among individuals free of AF at 55 years of age, those in low-polygenic and clinical risk tertiles had a lifetime risk of AF of 22.3% (95% confidence interval, 15.4-9.1), whereas those in high-risk tertiles had a risk of 48.2% (95% confidence interval, 41.3-55.1). A lower clinical risk factor burden was associated with later AF onset after adjusting for genetic predisposition (P<0.001).ConclusionsIn our community-based cohort, the lifetime risk of AF was 37%. Estimation of polygenic AF risk is feasible and together with clinical risk factor burden explains a substantial gradient in long-term AF risk.
| S-EPMC5840011 | biostudies-literature
Project description:ImportanceWithout third-party insurance, access to marketed drugs is limited to those who can afford to pay. We examined this phenomenon in the context of anticoagulation for patients with nonvalvular atrial fibrillation (NVAF).ObjectiveTo determine whether, among older Ontarians receiving anticoagulation for NVAF, patients of higher socioeconomic status (SES) were more likely to switch from warfarin to dabigatran prior to its addition to the provincial formulary.Design, setting and participantsPopulation-based retrospective cohort study of Ontarians aged 66 years and older, between 2008 and 2012.ExposureSocioeconomic status, as approximated by median neighborhood income.Main outcomes and measureWe identified two groups of older adults with nonvalvular atrial fibrillation: those who appeared to switch from warfarin to dabigatran after its market approval but prior to its inclusion on the provincial formulary ("switchers"), and those with ongoing warfarin use during the same interval ("non-switchers").ResultsWe studied 34,797 patients, including 3183 "switchers" and 31,614 "non-switchers". We found that higher SES was associated with switching to dabigatran prior to its coverage on the provincial formulary (p<0.0001). In multivariable analysis, subjects in the highest quintile were 50% more likely to switch to dabigatran than those in the lowest income quintile (11.3% vs. 7.3%; adjusted odds ratio 1.50; 95% CI 1.32 to 1.68). Following dabigatran's addition to the formulary, the income gradient disappeared.Conclusions and relevanceWe documented socioeconomic inequality in access to dabigatran among patients receiving warfarin for NVAF. This disparity was eliminated following the drug's addition to the provincial formulary, highlighting the importance of timely reimbursement decisions.
| S-EPMC4767939 | biostudies-literature
Project description:Despite some common risk factors for atrial fibrillation (AF) being more prevalent among blacks, African Americans are increasingly being reported with lower prevalence and incidence of AF compared with whites. Contemporary studies have not provided a complete explanation for this apparent AF paradox in African Americans. Although many traditional and novel risk factors for AF have been identified, the role of ethnic-specific risk factors has not been examined. Whereas hypertension has been the most common risk factor associated with AF, coronary artery disease also plays an important role in AF pathophysiology in whites. Thereby, elucidating the role of ethnic-specific risk factors for AF may provide important insight into why African Americans are protected from AF or why whites are more prone to develop the arrhythmia. The link between AF susceptibility and genetic processes has only been recently uncovered. Polymorphisms in renin-angiotensin system genes have been characterized as predisposing to AF under certain environmental conditions. Several ion channel genes, signaling molecules, and several genetic loci have been linked with AF. Thereby, studies investigating genetic variants contributing to the differential AF risk in individuals of African American versus European ancestry may also provide important insight into the etiology of the AF paradox in blacks.
| S-EPMC3137277 | biostudies-literature
Project description:AimsHeart failure (HF) has shared genetic architecture with its risk factors: atrial fibrillation (AF), body mass index (BMI), coronary heart disease (CHD), systolic blood pressure (SBP), and type 2 diabetes (T2D). We aim to assess the association and risk prediction performance of risk-factor polygenic risk scores (PRSs) for incident HF and its subtypes in bi-racial populations.Methods and resultsFive PRSs were constructed for AF, BMI, CHD, SBP, and T2D in White participants of the Atherosclerosis Risk in Communities (ARIC) study. The associations between PRSs and incident HF and its subtypes were assessed using Cox models, and the risk prediction performance of PRSs was assessed using C statistics. Replication was performed in the ARIC study Black and Cardiovascular Health Study (CHS) White participants. In 8624 ARIC study Whites, 1922 (31% cumulative incidence) HF cases developed over 30 years of follow-up. PRSs of AF, BMI, and CHD were associated with incident HF (P < 0.001), where PRSAF showed the strongest association [hazard ratio (HR): 1.47, 95% confidence interval (CI): 1.41-1.53]. Only the addition of PRSAF to the ARIC study HF risk equation improved C statistics for 10 year risk prediction from 0.812 to 0.829 (∆C: 0.017, 95% CI: 0.009-0.026). The PRSAF was associated with both incident HF with reduced ejection fraction (HR: 1.43, 95% CI: 1.27-1.60) and incident HF with preserved ejection fraction (HR: 1.46, 95% CI: 1.33-1.62). The associations between PRSAF and incident HF and its subtypes, as well as the improved risk prediction, were replicated in the ARIC study Blacks and the CHS Whites (P < 0.050). Protein analyses revealed that N-terminal pro-brain natriuretic peptide and other 98 proteins were associated with PRSAF.ConclusionsThe PRSAF was associated with incident HF and its subtypes and had significant incremental value over an established HF risk prediction equation.
| S-EPMC10966276 | biostudies-literature
Project description:BackgroundAge is the strongest predictor of atrial fibrillation (AF), yet little is known about AF incidence in the oldest old.HypothesisAF incidence declines after age 90 years, and morbidity is compressed into a brief period at the end of life.MethodsIn this retrospective, longitudinal cohort study of patients (born 1905-1935), we examined cumulative lifetime incidence of AF and its impact on mortality. Data included records from 1 062 610 octogenarians, 317 161 nonagenarians, and 3572 centenarians. Kaplan-Meier curves were used to estimate cumulative incidence of AF by age group, incidence rates were compared using log-rank tests, and Cox proportional hazards model was used to estimate unadjusted hazard ratios. The primary outcome was AF incidence at age > 80 years; the secondary outcome was mortality.ResultsThe cumulative AF incidence rate was 5.0% in octogenarians, 5.4% in nonagenarians, and 2.3% in centenarians. Octogenarians and nonagenarians had a higher risk of AF incidence compared to centenarians (adjusted hazard ratio 8.74, 95% confidence interval [CI]: 6.31-12.04; and 2.98, 95% CI: 2.17-4.1, respectively). The lowest hazard ratio for mortality in patients with AF compared to those without was 2.3 (95% CI: 2.3-2.4) in patients who were on antiplatelet and anticoagulant medication and had a score of 0 on the Elixhauser comorbidity index score.ConclusionsAlthough AF incidence increased with age, being a centenarian was associated with reduced incidence and compression of morbidity. Patients with AF had a higher adjusted mortality rate. However, data suggest that a regimen of anticoagulants and antiplatelets may reduce risk of mortality in patients over 80 with an AF diagnosis.
| S-EPMC6349030 | biostudies-literature
Project description:ImportanceSocioeconomic status (SES) has an important association with cognitive function and structural brain indices. Identifying the nature of this association will guide strategies for improving health equity.ObjectiveTo test the longitudinal associations of SES with cognitive decline and brain characteristics and to examine whether these associations differ between Black and White individuals.Design, setting, and participantsParticipants aged 65 years old or older were recruited for this population-based cohort study from 4 communities on the south side of Chicago, Illinois. At-home interviews were conducted between 1993 and 2012. The data were analyzed in April 2024.Main outcomes and measuresOutcome measures were level and change in global cognition and 4 individual tests. Three magnetic resonance imaging (MRI) measures of the brain included total brain volume, hippocampal volumes, and white matter hyperintensities (WMH). Childhood SES was assessed using parental education levels, father's occupation, and childhood finance rating. Adulthood SES was assessed using the participants' education, occupation, and income. Lifetime SES was assessed on the basis of the mother's education, childhood SES, and participants' occupation and income.ResultsOf the 7303 participants (mean [SD] age, 72.3 [6.3] years; 4573 female participants [63%]), 4581 (63%) were non-Hispanic Black, and 2722 (37%) were non-Hispanic White. SES was higher for White individuals compared with Black individuals in childhood, adulthood, and across the lifespan. Higher lifetime SES was associated with better global cognitive functioning at baseline (estimate, 0.337; 95% CI, 0.317 to 0.357; P < .001) but not with decline over time (estimate, 0.003; 95% CI, -0.001 to 0.006; P = .10). Higher lifetime SES was associated with a better baseline score on the Mini-Mental State Examination (estimate, 0.281; 95% CI, 0.261 to 0.302; P < .001) and a slower decline for all participants (estimate, 0.012; 95% CI, 0.008 to 0.016; P < .001). In a subset of 933 participants who underwent MRI, there was an association between lifetime SES and healthier brain structures, as measured by total brain volume (estimate, 3.18; 95% CI, 0.20 to 6.17; P = .04) and WMH burden (estimate, -0.11; 95% CI, -0.21 to -0.01; P = .03).Conclusions and relevanceIn this cohort study, SES, mainly in adulthood, was associated with a person's cognitive status and brain structure, resulting in a discrepancy in cognitive status over time. These findings point to a need for interventions that improve SES throughout the lifespan, particularly for Black individuals, who had lower SES than White individuals.
| S-EPMC11846010 | biostudies-literature
Project description:Black race has been shown to be a risk factor for amputation in peripheral artery disease (PAD); however, race has been argued to be a marker for socioeconomic status (SES) rather than true disparity. The aim of this study is to study the impact of race and SES on amputation risk in PAD patients. Patients with incident PAD in the national Veterans Affairs Corporate Data Warehouse were identified from 2003 to 2014 (N=155 647). The exposures were race and SES (measured by median income in residential ZIP codes). The outcome was incident major amputation. Black veterans were significantly more likely to live in low-SES neighborhoods and to present with advanced PAD. Black patients had a higher amputation risk in each SES stratum compared with white patients. In Cox models (adjusting for covariates), black race was associated with a 37% higher amputation risk compared with white race (hazard ratio: 1.37; 95% confidence interval, 1.30-1.45), whereas low SES was independently predictive of increased risk of amputation (hazard ratio: 1.12; 95% confidence interval, 1.06-1.17) and showed no evidence of interaction with race. In predicted amputation risk analysis, black race and low SES continued to be significant risk factors for amputation regardless of PAD presentation. Black race significantly increases the risk of amputation within the same SES stratum compared with white race and has an independent effect on limb loss after controlling for comorbidities, severity of PAD at presentation, and use of medications.
| S-EPMC5850162 | biostudies-literature
Project description:PurposeWe studied incident atrial fibrillation (AF) in the prospective community-based Multi-Ethnic Study of Atherosclerosis (MESA). Reportedly, non-Hispanic blacks (NHBs) have a lower AF burden compared with their non-Hispanic white (NHW) counterparts. Information on the epidemiology of AF in Hispanic and Asian populations is much more limited.MethodsWe excluded participants with a history of AF at enrollment. A total of 6721 MESA participants were monitored for the first AF event ascertained according to hospital discharge International Classification of Diseases, Ninth Revision, codes. Age- and sex-adjusted incidence rates (IRs) of AF were calculated per 1000 person-years of observation. IR ratios were calculated using NHWs as the reference group. Age- and sex-adjusted population attributable fractions (PAFs) of established modifiable AF risk factors were ascertained.ResultsIn the MESA cohort, 47.2% was male; at baseline, 25.7% had hypertension; 12.5% had diabetes. Three hundred five incident hospitalized AF events occurred over a mean follow-up of 7.3 years. Age- and sex-adjusted IRs and IR ratios showed that overall AF incidence was significantly lower among Hispanics, NHBs and Chinese compared with NHWs (all P < .001). Among participants 65 years of age or greater, Hispanics, Chinese, and blacks had significantly lower AF incidence than NHWs (all P ≤ .01), but IRs were similar among participants under age 65 years. The PAF for smoking was 27% among NHBs but lower among other race-ethnic groups. Among NHWs, the PAF for hypertension was 22.2%, but this was higher among NHBs (33.1%), Chinese (46.3%), and Hispanics (43.9%).ConclusionsOverall, the incidence of hospitalized AF was significantly lower in Hispanics, NHBs, and Chinese than in NHWs. A larger proportion of AF events appear to be attributable to hypertension among nonwhite populations compared with NHWs.
| S-EPMC4559265 | biostudies-literature