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AF risk higher for white adults than other races
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White adults appear to have an increased risk for incident atrial fibrillation when compared with black, Asian and Hispanic adults.
Researchers conducted a hospital-based cohort study to examine the association between race and incident AF using the Healthcare Cost and Utilization Project to identify patients who received care at California hospitals from 2005 to 2009.
The study period covered 13,967,949 patients. During a median of 3.2 years, 375,318 incident AF episodes were observed. The overall incidence of AF was 9.03 per 1,000 patient-years.
After adjustment for patient demographics and established AF risk factors, blacks (HR=0.84; 95% CI, 0.82-0.85), Hispanics (HR=0.78; 95% CI, 0.77-0.79) and Asians (HR=0.78; 95% CI, 0.77-0.79) all had a lower risk for incident AF compared with whites.
“These data indicate that an unidentified characteristic inherent to white race increases AF risk,” the researchers wrote.
Differences in AF risk between the races decreased with time, and narrowed by approximately two percentage points for each decade increase in age. White adults had an adjusted 32% increased risk for AF at age 50 years compared with other races (HR=1.32; 95% CI, 1.3-1.34), but an adjusted 25% increased risk for AF at age 80 years compared with other races (HR=1.25; 95% CI, 1.24-1.26). Additionally, white men were at greater risk for incident AF than white women (HR=1.29; 95% CI, 1.28-1.31 vs. HR=1.24; 95% CI, 1.23-1.25).
The hazard for AF among white adults was higher in the absence of comorbidities such as hypertension, diabetes, CAD, HF, cardiothoracic surgery, valvular disease, pulmonary disease and chronic kidney disease. The presence of those comorbidities diminished the elevated hazard for AF in whites vs. nonwhites, and in the cases of HF, valvular disease and chronic kidney disease, reversed it.
In other results, Hispanic (HR=0.71; 95% CI, 0.69-0.73) and Asian (HR=0.81; 95% CI, 0.79-0.83) adults had a lower adjusted risk for incident atrial flutter compared with white adults; risk was higher for black adults (HR=1.09; 95% CI, 1.06-1.12).
“The differential risk for AF vs. [atrial flutter] by race could suggest that the racial differences in AF may in part be secondary differences in left atrial anatomic substrate (vs. electrical triggers), potentially identifying a mechanism underlying the race-AF association that warrants future investigation,” the researchers wrote. It also could indicate that some clinicians confused the diagnoses of AF and atrial flutter, they said.
Disclosure: The researchers report no relevant financial disclosures.
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