Ethnicity and the first diagnosis of a wide range of cardiovascular diseases: Associations in a linked electronic health record cohort of 1 million patients
Ethnicity and the first diagnosis of a wide range of cardiovascular diseases: Associations in a linked electronic health record cohort of 1 million patients
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DOI：
10.1371/journal.pone.0178945
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发表时间：
2017-06-09
期刊：
影响因子：
3.7
通讯作者：
Hemingway, Harry
中科院分区：
文献类型：
--
作者：
George, Julie;Mathur, Rohini;Hemingway, Harry
研究背景虽然种族与个体心血管疾病的关系已经被研究过，但对当代人群中临床心血管疾病的初始终生表现的种族差异知之甚少。方法和结果我们研究了1，068，318人，年龄≥ 30岁，基线时未诊断为心血管疾病（90.9%白色，3.6%南亚人和2.9%黑人），使用英文链接的电子健康记录，涵盖初级保健，住院，急性冠状动脉综合征登记和死亡登记（CALIBER平台）。在1997年至2010年的5.7年中位随访期间，95，224人经历了心血管诊断事件。60岁以下南亚患者中69.9%（67.2%-72.4%）的初始表现为冠心病表现，而白色患者为47.8%（47.3%-48.3%），黑人患者为40.1%（36.3%-43.9%）。与白色患者相比，黑人患者在所有冠状动脉疾病诊断的初始终生表现中具有显著较低的年龄-性别校正的风险比（HR（稳定型心绞痛HR 0.80（95% CI 0.68-0.93）;不稳定型心绞痛-0.75（0.59-0.97）;心肌梗死0.49（0.40-0.62）），而南亚患者的HR显著更高（稳定型心绞痛-1.67（1.52-1.84）;不稳定型心绞痛1.82（1.56-2.13）;心肌梗死-1.67（1.49-1.87）。我们发现在心力衰竭的初始表现中没有种族差异（黑人0.97（0.79-1.20）;南亚人1.04（0.87-1.26））。与白色患者相比，黑人患者更可能出现缺血性卒中（1.24（0.97-1.58））和脑出血（1.44（0.97-2.12））。黑人不太可能出现外周动脉疾病（0.63（0.50-0.80））和南亚患者（0.70（0.57-0.86））与白色患者相比。讨论虽然我们发现预期的南亚人冠心病表现的显著优势和黑人患者中风表现的优势，我们发现在心力衰竭的表现上没有种族差异。我们认为我们的研究结果的公共卫生和研究的影响。
BackgroundWhile the association of ethnic group with individual cardiovascular diseases has been studied, little is known about ethnic differences in the initial lifetime presentation of clinical cardiovascular disease in contemporary populations.Methods and resultsWe studied 1,068,318 people, aged >= 30 years and free from diagnosed CVD at baseline (90.9% White, 3.6% South Asian and 2.9% Black), using English linked electronic health records covering primary care, hospital admissions, acute coronary syndrome registry and mortality registry (CALIBER platform). During 5.7 years median follow-up between 1997-2010, 95,224 people experienced an incident cardiovascular diagnosis. 69.9% (67.2%-72.4%) of initial presentation in South Asian < 60 yrs were coronary heart disease presentations compared to 47.8% (47.3%-48.3%) in White and 40.1% (36.3%-43.9%) in Black patients. Compared to White patients, Black patients had significantly lower age-sex adjusted hazard ratios (HRs) for initial lifetime presentation of all the coronary disease diagnoses (stable angina HR 0.80 (95% CI 0.68-0.93); unstable angina-0.75 (0.59-0.97); myocardial infarction 0.49 (0.40-0.62)) while South Asian patients had significantly higher HRs (stable angina-1.67 (1.52-1.84); unstable angina 1.82 (1.56-2.13); myocardial infarction-1.67 (1.49-1.87). We found no ethnic differences in initial presentation with heart failure (Black 0.97 (0.79-1.20); S Asian 1.04(0.87-1.26)). Compared to White patients, Black patients were more likely to present with ischaemic stroke (1.24 (0.97-1.58)) and intracerebral haemorrhage (1.44 (0.97-2.12)). Presentation with peripheral arterial disease was less likely for Black (0.63 (0.50-0.80)) and South Asian patients (0.70 ( 0.57-0.86)) compared with White patients.DiscussionWhile we found the anticipated substantial predominance of coronary heart disease presentations in South Asian and predominance of stroke presentations in Black patients, we found no ethnic differences in presentation with heart failure. We consider the public health and research implications of our findings.