种族差异与心源性猝死
Racial Differences in Sudden Cardiac Death.
机构信息
Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (D.Z., W.S.P., E.B.-C., E.D.M., E.G.).
Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (W.S.P., A.C., E.D.M.).
出版信息
Circulation. 2019 Apr 2;139(14):1688-1697. doi: 10.1161/CIRCULATIONAHA.118.036553.
BACKGROUND
Blacks have a higher incidence of out-of-hospital sudden cardiac death (SCD) in comparison with whites. However, the racial differences in the cumulative risk of SCD and the reasons for these differences have not been assessed in large-scale community-based cohorts. The objective of this study is to compare the lifetime cumulative risk of SCD among blacks and whites, and to evaluate the risk factors that may explain racial differences in SCD risk in the general population.
METHODS
This is a cohort study of 3832 blacks and 11 237 whites participating in the Atherosclerosis Risk in Communities Study (ARIC). Race was self-reported. SCD was defined as a sudden pulseless condition from a cardiac cause in a previously stable individual, and SCD cases were adjudicated by an expert committee. Cumulative incidence was computed using competing risk models. Potential mediators included demographic and socioeconomic factors, cardiovascular risk factors, presence of coronary heart disease, and electrocardiographic parameters as time-varying factors.
RESULTS
The mean (SD) age was 53.6 (5.8) years for blacks and 54.4 (5.7) years for whites. During 27.4 years of follow-up, 215 blacks and 332 whites experienced SCD. The lifetime cumulative incidence of SCD at age 85 years was 9.6, 6.6, 6.5, and 2.3% for black men, black women, white men, and white women, respectively. The sex-adjusted hazard ratio for SCD comparing blacks with whites was 2.12 (95% CI, 1.79-2.51). The association was attenuated but still statistically significant in fully adjusted models (hazard ratio, 1.38; 95% CI, 1.11-1.71). In mediation analysis, known factors explained 65.3% (95% CI 37.9-92.8%) of the excess risk of SCD in blacks in comparison with whites. The single most important factor explaining this difference was income (50.5%), followed by education (19.1%), hypertension (22.1%), and diabetes mellitus (19.6%). Racial differences were evident in both genders but stronger in women than in men.
CONCLUSIONS
Blacks had a much higher risk for SCD in comparison with whites, particularly among women. Income, education, and traditional risk factors explained ≈65% of the race difference in SCD. The high burden of SCD and the racial-gender disparities observed in our study represent a major public health and clinical problem.
背景
与白人相比，黑人患有院外心源性猝死（SCD）的发病率更高。然而，在大规模社区队列中，尚未评估 SCD 的累积风险的种族差异以及导致这些差异的原因。本研究的目的是比较黑人和白人一生中 SCD 的累积风险，并评估可能解释 SCD 风险在普通人群中种族差异的危险因素。
方法
这是一项对参加动脉粥样硬化风险社区研究（ARIC）的 3832 名黑人参与者和 11237 名白人参与者进行的队列研究。种族由自我报告确定。SCD 被定义为先前稳定个体的心脏原因引起的突然无脉搏状态，SCD 病例由专家委员会裁决。使用竞争风险模型计算累积发生率。潜在的中介因素包括人口统计学和社会经济因素、心血管危险因素、冠心病的存在以及心电图参数作为时变因素。
结果
黑人的平均（SD）年龄为 53.6（5.8）岁，白人的平均（SD）年龄为 54.4（5.7）岁。在 27.4 年的随访期间，215 名黑人参与者和 332 名白人参与者经历了 SCD。85 岁时 SCD 的终生累积发生率分别为黑人男性 9.6%、6.6%、6.5%和 2.3%，黑人女性为 9.6%、6.6%、6.5%和 2.3%，白人男性为 2.3%、9.6%、6.5%和 2.3%，白人女性为 2.3%。与白人相比，黑人 SCD 的性别调整风险比为 2.12（95%CI，1.79-2.51）。在完全调整模型中，该关联虽然减弱但仍具有统计学意义（风险比，1.38；95%CI，1.11-1.71）。在中介分析中，已知因素解释了黑人 SCD 风险比白人高 65.3%（95%CI，37.9-92.8%）的 65.3%（95%CI，37.9-92.8%）。解释这种差异的最重要因素是收入（50.5%），其次是教育（19.1%）、高血压（22.1%）和糖尿病（19.6%）。种族差异在两性中均存在，但在女性中比男性更明显。
结论
与白人相比，黑人患 SCD 的风险高得多，尤其是女性。收入、教育和传统危险因素解释了 SCD 种族差异的 ≈65%。我们研究中观察到的 SCD 负担高和种族性别差异是一个主要的公共卫生和临床问题。
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