Ethnicity and the first diagnosis of a wide range of cardiovascular diseases: Associations in a linked electronic health record cohort of 1 million patients.
<h4>Background</h4>While 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.<h4>Methods and results<...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2017-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0178945&type=printable |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849734954939842560 |
|---|---|
| author | Julie George Rohini Mathur Anoop Dinesh Shah Mar Pujades-Rodriguez Spiros Denaxas Liam Smeeth Adam Timmis Harry Hemingway |
| author_facet | Julie George Rohini Mathur Anoop Dinesh Shah Mar Pujades-Rodriguez Spiros Denaxas Liam Smeeth Adam Timmis Harry Hemingway |
| author_sort | Julie George |
| collection | DOAJ |
| description | <h4>Background</h4>While 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.<h4>Methods and results</h4>We 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.<h4>Discussion</h4>While 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.<h4>Trial registration</h4>NCT02176174, www.clinicaltrials.gov. |
| format | Article |
| id | doaj-art-90675f71ada044af82e162aa771fce51 |
| institution | DOAJ |
| issn | 1932-6203 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-90675f71ada044af82e162aa771fce512025-08-20T03:07:40ZengPublic Library of Science (PLoS)PLoS ONE1932-62032017-01-01126e017894510.1371/journal.pone.0178945Ethnicity and the first diagnosis of a wide range of cardiovascular diseases: Associations in a linked electronic health record cohort of 1 million patients.Julie GeorgeRohini MathurAnoop Dinesh ShahMar Pujades-RodriguezSpiros DenaxasLiam SmeethAdam TimmisHarry Hemingway<h4>Background</h4>While 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.<h4>Methods and results</h4>We 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.<h4>Discussion</h4>While 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.<h4>Trial registration</h4>NCT02176174, www.clinicaltrials.gov.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0178945&type=printable |
| spellingShingle | Julie George Rohini Mathur Anoop Dinesh Shah Mar Pujades-Rodriguez Spiros Denaxas Liam Smeeth Adam Timmis Harry Hemingway Ethnicity and the first diagnosis of a wide range of cardiovascular diseases: Associations in a linked electronic health record cohort of 1 million patients. PLoS ONE |
| title | Ethnicity and the first diagnosis of a wide range of cardiovascular diseases: Associations in a linked electronic health record cohort of 1 million patients. |
| title_full | Ethnicity and the first diagnosis of a wide range of cardiovascular diseases: Associations in a linked electronic health record cohort of 1 million patients. |
| title_fullStr | Ethnicity and the first diagnosis of a wide range of cardiovascular diseases: Associations in a linked electronic health record cohort of 1 million patients. |
| title_full_unstemmed | Ethnicity and the first diagnosis of a wide range of cardiovascular diseases: Associations in a linked electronic health record cohort of 1 million patients. |
| title_short | Ethnicity and the first diagnosis of a wide range of cardiovascular diseases: Associations in a linked electronic health record cohort of 1 million patients. |
| title_sort | ethnicity and the first diagnosis of a wide range of cardiovascular diseases associations in a linked electronic health record cohort of 1 million patients |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0178945&type=printable |
| work_keys_str_mv | AT juliegeorge ethnicityandthefirstdiagnosisofawiderangeofcardiovasculardiseasesassociationsinalinkedelectronichealthrecordcohortof1millionpatients AT rohinimathur ethnicityandthefirstdiagnosisofawiderangeofcardiovasculardiseasesassociationsinalinkedelectronichealthrecordcohortof1millionpatients AT anoopdineshshah ethnicityandthefirstdiagnosisofawiderangeofcardiovasculardiseasesassociationsinalinkedelectronichealthrecordcohortof1millionpatients AT marpujadesrodriguez ethnicityandthefirstdiagnosisofawiderangeofcardiovasculardiseasesassociationsinalinkedelectronichealthrecordcohortof1millionpatients AT spirosdenaxas ethnicityandthefirstdiagnosisofawiderangeofcardiovasculardiseasesassociationsinalinkedelectronichealthrecordcohortof1millionpatients AT liamsmeeth ethnicityandthefirstdiagnosisofawiderangeofcardiovasculardiseasesassociationsinalinkedelectronichealthrecordcohortof1millionpatients AT adamtimmis ethnicityandthefirstdiagnosisofawiderangeofcardiovasculardiseasesassociationsinalinkedelectronichealthrecordcohortof1millionpatients AT harryhemingway ethnicityandthefirstdiagnosisofawiderangeofcardiovasculardiseasesassociationsinalinkedelectronichealthrecordcohortof1millionpatients |