Racial and Ethnic Differences in Incident Hospitalized Heart Failure in Postmenopausal Women The Women's Health Initiative
Racial and Ethnic Differences in Incident Hospitalized Heart Failure in Postmenopausal Women The Women's Health Initiative
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DOI：
10.1161/circulationaha.111.066688
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发表时间：
2012-08-07
期刊：
影响因子：
37.8
通讯作者：
Howard, Barbara V.
中科院分区：
文献类型：
--
作者：
Eaton, Charles B.;Abdulbaki, Abdulrahman M.;Howard, Barbara V.
背景-不同种族/民族心力衰竭发病率的差异和这些差异的潜在机制在很大程度上是未知的women.Methods和结果-共156 143绝经后妇女自由自我-1993年至1998年，作为妇女健康倡议的一部分，在美国40个临床中心登记了30例报告心力衰竭的患者，并随访至2005年，平均为7.8年，因心力衰竭住院。通过使用比较种族/民族组的考克斯比例风险模型确定发病率、风险比（HR）和95%置信区间，并计算每个种族/民族组的人群归因风险百分比。黑人的心力衰竭年龄调整发生率最高（380/100000人-年），其次是白人（274），西班牙裔（193）和亚洲/太平洋岛民（103）。与白人相比，黑人的过度风险（年龄调整HR=1.45）通过调整家庭收入显著减弱（HR=0.97）和糖尿病（HR=0.89），但西班牙裔的风险较低（年龄调整HR=0.72）和亚洲/太平洋岛民（年龄调整的HR=0.44）仍然存在，尽管调整了传统的风险因素，社会经济地位，生活方式和获得护理的变量。调整非白色与白色HR的临时冠心病的影响不同的种族/ethnic group. Conclusions亚洲/太平洋岛民和西班牙裔妇女有较低的心力衰竭的发病率和黑人妇女有较高的心力衰竭率相比，白色妇女。黑人女性发生心力衰竭的过度风险主要是通过调整黑人女性较低的家庭收入和糖尿病来解释的，而本研究中测量的风险因素在很大程度上无法解释亚洲/太平洋岛民和西班牙裔的心力衰竭发生率较低。
Background-The differences in the incidence of heart failure by race/ethnicity and the potential mechanisms for these differences are largely unexplored in women.Methods and Results-A total of 156 143 postmenopausal women free of self-reported heart failure enrolled from 1993 to 1998 at 40 clinical centers throughout the United States as part of the Women's Health Initiative and were followed up until 2005, for an average of 7.8 years, for incident hospitalized heart failure. Incident rates, hazard ratios (HRs), and 95% confidence intervals were determined by use of the Cox proportional hazard model comparing racial/ethnic groups, and population-attributable risk percentages were calculated for each racial/ethnic group. Blacks had the highest age-adjusted incidence of heart failure (380 in 100 000 person-years), followed by whites (274), Hispanics (193), and Asian/Pacific Islanders (103). The excess risk in blacks compared with whites (age-adjusted HR=1.45) was significantly attenuated by adjustment for household income (HR=0.97) and diabetes mellitus (HR=0.89), but the lower risk in Hispanics (age-adjusted HR=0.72) and Asian/Pacific Islanders (age-adjusted HR=0.44) remained despite adjustment for traditional risk factors, socioeconomic status, lifestyle, and access-to-care variables. The effect of adjustment for interim coronary heart disease on nonwhite versus white HRs for heart failure differed by race/ethnic group.Conclusions-Asian/Pacific Islander and Hispanic women have a lower incidence of heart failure and black women have higher rates of heart failure compared with white women. The excess risk of incident heart failure in black women is explained largely by adjustment for lower household incomes and diabetes mellitus in black women, whereas the lower rates of heart failure in Asian/Pacific Islanders and Hispanics are largely unexplained by the risk factors measured in this study.