Shulman Eric, Kargoli Faraj, Aagaard Philip, Hoch Ethan, Di Biase Luigi, Fisher John, Gross Jay, Kim Soo, Ferrick Kevin J, Krumerman Andrew
Division of Cardiology, Department of Medicine, Montefiore Medical Center, New York.
Clin Cardiol. 2017 Sep;40(9):770-776. doi: 10.1002/clc.22732. Epub 2017 Jun 9.
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."
Lower SES among Hispanics and African Americans may help to explain the lower incidence rates of AF compared to non-Hispanic whites.
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.
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.
Our study suggests that non-Hispanic whites were at higher risk for AF compared to nonwhites, and this was independent of SES.
心房颤动（AF）是最常见的心律失常，与显著的发病率和死亡率相关。尽管非裔美国人和西班牙裔少数族裔的传统房颤危险因素负担更高，但与非西班牙裔白人相比，他们的房颤发病率较低，这被称为“种族悖论”。
西班牙裔和非裔美国人较低的社会经济地位（SES）可能有助于解释与非西班牙裔白人相比房颤发病率较低的原因。
对纽约州的心电图/电子病历数据库进行查询，以获取2000年至2013年无房颤的个体，以了解随后发生房颤的情况。通过将6项指标Z标准化至纽约州平均水平的综合指标，按邮政编码评估SES。SES被重新分类为十分位数组。使用控制所有基线差异的Cox回归分析来估计SES对房颤的独立预测能力。
我们确定了48631人（43%为西班牙裔，37%为非裔美国人，20%为非西班牙裔白人；平均年龄59岁；平均随访3.2年），其中发生了4556例房颤病例。在所有SES十分位数中，西班牙裔和非裔美国人的房颤风险低于白人（对数秩检验P<0.001）。较高的SES与较低的房颤风险存在临界关联（风险比：0.990，95%置信区间：0.980-1.001，P=0.061）。按SES十分位数对任何种族/族裔组进行的P趋势分析对房颤均无显著性。
我们的研究表明，与非白人相比，非西班牙裔白人患房颤的风险更高，且这与SES无关。
