Socioeconomic status and the incidence of atrial fibrillation in whites and blacks: the Atherosclerosis Risk in Communities (ARIC) study.
Socioeconomic status and the incidence of atrial fibrillation in whites and blacks: the Atherosclerosis Risk in Communities (ARIC) study.
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白人和黑人中房颤的社会经济状况和房颤的发生率：社区中的动脉粥样硬化风险（ARIC）研究。
DOI：
10.1161/jaha.114.001159
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发表时间：
2014-08-20
影响因子：
5.4
通讯作者：
Alonso A
中科院分区：
文献类型：
--
作者：
Misialek JR;Rose KM;Everson-Rose SA;Soliman EZ;Clark CJ;Lopez FL;Alonso A
以前没有研究探讨社会经济地位，性别和种族与房颤（AF）风险之间的相互作用。我们前瞻性地随访了14352例无AF并参与社区动脉粥样硬化风险（ARIC）研究的患者（25%黑人，75%白色，55%女性，平均年龄54岁）。社会经济地位在基线（1987-1989年）通过教育水平和家庭总收入进行评估。通过心电图、住院和死亡证明确定了2009年的AF事件。考克斯回归用于估计教育和家庭收入的AF风险比和95% CI。测试了社会经济地位与年龄、种族或性别之间的相互作用。在中位随访20.6年期间，发生了1794例AF病例。较低的家庭收入与较高的AF风险相关（年收入低于25 000美元的患者与年收入≥ 50 000美元的患者相比，风险比为1.45，95% CI为1.27至1.67）。教育与房颤风险之间的关联因性别而异（P=0.01），与最高教育组相比，最低教育组女性房颤风险较高（风险比1.88，95%CI 1.55至2.28），但男性则不然（风险比1.15，95%CI 0.97至1.36）。调整心血管危险因素后，这种关联减弱。与种族或年龄无相互作用。在所有收入和教育群体中，黑人的房颤风险低于白人。较低的家庭收入与总体上较高的AF风险相关，而教育对AF风险的影响仅存在于女性中。社会经济地位的差异并不能解释与白人相比，黑人AF的风险较低。
No previous studies have examined the interplay among socioeconomic status, sex, and race with the risk of atrial fibrillation (AF). We prospectively followed 14 352 persons (25% black, 75% white, 55% women, mean age 54 years) who were free of AF and participating in the Atherosclerosis Risk in Communities (ARIC) study. Socioeconomic status was assessed at baseline (1987–1989) through educational level and total family income. Incident AF through 2009 was ascertained from electrocardiograms, hospitalizations, and death certificates. Cox regression was used to estimate hazard ratios and 95% CIs of AF for education and family income. Interactions were tested between socioeconomic status and age, race, or sex. Over a median follow‐up of 20.6 years, 1794 AF cases occurred. Lower family income was associated with higher AF risk (hazard ratio 1.45, 95% CI 1.27 to 1.67 in those with income less than $25 000 per year compared with those with $50 000 or more per year). The association between education and AF risk varied by sex (P=0.01), with the lowest education group associated with higher AF risk in women (hazard ratio 1.88, 95% CI 1.55 to 2.28) but not in men (hazard ratio 1.15, 95% CI 0.97 to 1.36) compared with the highest education group. Adjustment for cardiovascular risk factors attenuated the associations. There were no interactions with race or age. Blacks had lower AF risk than whites in all income and education groups. Lower family income was associated with a higher AF risk overall, whereas the impact of education on AF risk was present only in women. Differences in socioeconomic status do not explain the lower risk of AF in blacks compared with whites.