Sex and racial differences in cardiovascular disease risk in patients with atrial fibrillation

• Type of Material: Article
• Authors: Wesley T. O'Neal, Emory University; Aniqa B. Alam, Emory University; Pratik Sandesara, Emory University; J'Neka S. Claxtono, Emory University; Richard F. MacLehose, University of Minnesota; Lin Y. Chen, University of Minnesota; Lindsay G. S. Bengtson, Life Sciences, Optum, Eden Prairie, Minnesota; Alanna M. Chamberlain, Mayo Clinic, Rochester, Minnesota; Faye L. Norby, University of Minnesota; Pamela L. Lutsey, University of Minnesota; Alvaro Alonso, Emory University
• Language: English
• Date: 2019-09-04
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: © 2019 O’Neal et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0222147
• Title of Journal or Parent Work: PLoS One
• Volume: 14
• Issue: 9
• Start Page: 1
• End Page: 13
• Grant/Funding Information: Research reported in this publication was funded by the National Heart, Lung, And Blood Institute of the National Institutes of Health under award numbers R01-HL122200 [authors ABA, JSC, RFM, LYC, FLN, PLL, AND AA] and F32-HL134290 [author WTO], and from the American Heart Association under award number 16EIA26410001 [author AA].; The funders provided support in the form of salaries for the authors attached to each grant, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript; hough author LGSB is employed by Optum, Optum did not provide funding for this publication.
• Keywords: intervention; gender; outcomes; race; biology; racial disparity; treatment; atrial fibrillation; ethnicity; risk factors
• Research Categories: Health Sciences, Public Health; Health Sciences, Health Care Management; Health Sciences, Epidemiology; Biology, Biostatistics

Abstract

Background: Outcomes among atrial fibrillation (AF) patients may differ according to race/ethnicity and sex due to differences in biology, the prevalence of cardiovascular risk factors, and the use and effectiveness of AF treatments. We aimed to characterize patterns of cardiovascular risk across subgroups of AF patients by sex and race/ethnicity, since doing so may provide opportunities to identify interventions. We also evaluated whether these patterns changed over time. Methods: We utilized administrative claims data from the Optum Clinformatics® Datamart database from 2009 to 2015. Patients with AF with ≥6 months of enrollment prior to the first non-valvular AF diagnosis were included in the analysis. Final analysis utilized Cox proportional hazard models to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for cardiovascular outcomes stratified by sex and race/ethnicity. An additional analysis stratified outcomes by calendar year of AF diagnosis to evaluate changes in outcomes over time. Results: In a cohort of 380,636 AF patients, women had a higher risk of ischemic stroke [HR (95% CI): 1.25 (1.19, 1.31)] and lower risk of heart failure and myocardial infarction [HR (95% CI): 0.91 (0.88, 0.94) and 0.81 (0.77, 0.86), respectively)] compared to men. Black patients had elevated risk across all endpoints compared to whites, while Hispanics and Asian Americans showed no significant differences in any outcome compared to white patients. These sex and race/ethnic differences did not change over time. Conclusions: We found sex and race/ethnic differences in risk of cardiovascular outcomes among AF patients, without evidence of improvement over time.