Open AccessSocioeconomic status and the development of atrial fibrillation in Hispanics, African Americans and non‐Hispanic whites
Author(s) -
Shulman Eric,
Kargoli Faraj,
Aagaard Philip,
Hoch Ethan,
Di Biase Luigi,
Fisher John,
Gross Jay,
Kim Soo,
Ferrick Kevin J.,
Krumerman Andrew
Publication year - 2017
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22732
Subject(s) - medicine , decile , demography , hazard ratio , confidence interval , socioeconomic status , incidence (geometry) , atrial fibrillation , non hispanic whites , proportional hazards model , ethnic group , gerontology , population , mexican americans , environmental health , statistics , physics , mathematics , sociology , anthropology , optics
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 48 631 persons (43% Hispanic, 37% African Americans, and 20% non‐Hispanic white; mean age 59 years; mean follow‐up of 3.2 years) 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 .