心房颤动发病率、与种族相关的危险因素以及心房颤动危险因素的人群归因分数：动脉粥样硬化多族裔研究
Atrial fibrillation incidence and risk factors in relation to race-ethnicity and the population attributable fraction of atrial fibrillation risk factors: the Multi-Ethnic Study of Atherosclerosis.
作者信息
Rodriguez Carlos J, Soliman Elsayed Z, Alonso Alvaro, Swett Katrina, Okin Peter M, Goff David C, Heckbert Susan R
机构信息
Department of Medicine, Wake Forest University School of Medicine, Winston Salem, NC; Department of Epidemiology & Prevention, Wake Forest University School of Medicine, Winston Salem, NC.
Department of Medicine, Wake Forest University School of Medicine, Winston Salem, NC; Department of Epidemiology & Prevention, Wake Forest University School of Medicine, Winston Salem, NC.
出版信息
Ann Epidemiol. 2015 Feb;25(2):71-6, 76.e1. doi: 10.1016/j.annepidem.2014.11.024. Epub 2014 Nov 28.
PURPOSE
We 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.
METHODS
We 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.
RESULTS
In 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%).
CONCLUSIONS
Overall, 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.
目的
我们在基于社区的前瞻性多民族动脉粥样硬化研究（MESA）中对新发房颤（AF）进行了研究。据报道，与非西班牙裔白人（NHW）相比，非西班牙裔黑人（NHB）的房颤负担较低。关于西班牙裔和亚洲人群房颤流行病学的信息则更为有限。
方法
我们排除了入组时患有房颤病史的参与者。对总共6721名MESA参与者进行监测，以确定首次发生的房颤事件，该事件根据医院出院的《国际疾病分类》第九版编码确定。按每1000人年观察期计算年龄和性别调整后的房颤发病率（IR）。以NHW作为参照组计算IR比值。确定已确立的可改变房颤危险因素的年龄和性别调整后的人群归因分数（PAF）。
结果
在MESA队列中，47.2%为男性；基线时，25.7%患有高血压；12.5%患有糖尿病。在平均7.3年的随访期间，共发生305例因房颤住院的新发事件。年龄和性别调整后的IR及IR比值显示，与NHW相比，西班牙裔、NHB和中国人的总体房颤发病率显著较低（所有P<0.001）。在65岁及以上的参与者中，西班牙裔、中国人和黑人房颤发病率显著低于NHW（所有P≤0.01），但65岁以下参与者的IR相似。吸烟的PAF在NHB中为27%，但在其他种族/族裔群体中较低。在NHW中，高血压的PAF为22.2%，但在NHB（33.1%）、中国人（46.3%）和西班牙裔（43.9%）中更高。
结论
总体而言，西班牙裔、NHB和中国人因房颤住院的发病率显著低于NHW。与NHW相比，非白人人群中更大比例的房颤事件似乎可归因于高血压。
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