Brief ReportEthnic Differences in Risk of Coronary Heart Disease in a Large Contemporary Population
Introduction
Racial/ethnic differences in diabetes mellitus (DM) and cardiovascular disease are well documented, but population health estimates are often confounded by differences in access to quality health care.1 Inequities and disparities in health outcomes by race/ethnicity and also by income status are persistent and difficult to reduce.2 The IOM report Crossing the Quality Chasm: A New Health System for the 21st Century3 considered equity among six critical features for healthcare quality.
Whereas many studies have shown sizable differences in outcomes between blacks and whites, evidence from the other minority groups is lacking.4 Given the Affordable Care Act’s recent broadening of healthcare access, updated benchmarks established from ethnically diverse populations with uniform healthcare coverage are needed. To address this knowledge gap, and to inform and help reduce health inequalities, this study sought to evaluate ethnic differences in risk of future coronary heart disease (CHD) in patient populations stratified by status of DM and prior CHD in a population with uniform access to care.
Section snippets
Methods
Kaiser Permanente Northern California is a large, integrated healthcare delivery system, caring for >3 million people who are broadly representative of the service area.5, 6 A cohort was constructed of 1,344,899 members with self-reported race/ethnicity, aged 30–90 years at baseline, January 1, 2002, and was followed through December 31, 2012, with censoring after outcome event, end of health plan membership, or death. Individuals were excluded if they were not continuously enrolled during the
Results
The median follow-up was 10 years (10,980,800 person-years). Although 64% of the population was white, there was still a large proportion of Asians (n=190,439); Latinos (n=169,886); and blacks (n=116,273). Whites were older and almost one fifth of blacks were from economically disadvantaged neighborhoods (Table 1).
The exposure of interest included four clinical risk categories defined by presence or absence of diabetes and prior CHD (no DM/no CHD, no DM/prior CHD, DM/no CHD, DM/prior CHD). Race
Discussion
Pervasive racial/ethnic differences in DM, cardiovascular disease, and their risk factors remain an important societal problem.8 It has been suggested that to reduce inequity, healthcare organizations should explore reasons that contribute to disproportionate lack of access.2
Kaiser Permanente is an integrated healthcare delivery system with uniform access to health care, and the present study found slightly reduced or no difference in risk for blacks, Asians, and Latinos compared with whites
Conclusions
Much is still needed to address the differences in health status and outcomes related to race/ethnicity.12 These findings may inform policy development and interventions designed to identify and eliminate racial/ethnic differences.
Acknowledgments
This study was supported by a grant from the Kaiser Permanente Northern California Community Benefit Program, which had no role in the study design or activities.
No financial disclosures were reported by the authors of this paper.
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Cited by (8)
Cardiovascular outcomes of antidiabetes medications by race/ethnicity: A systematic review and meta-analysis
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South Asian ethnicity as a risk factor for coronary heart disease
2020, AtherosclerosisCitation Excerpt :An analysis of the California Mortality Database from the 1990 and 2000 census data demonstrated a general decline in CHD mortality from the prior decade, except in Asian Indian women, who experienced a 5% increase in CHD mortality [10]. Recent analysis of a Kaiser Permanente Northern California (KPNC) cohort identified a lower CHD incidence in Asians, as compared to Whites, from 2002 to 2012, but the classification is notably a composite of all Asians and without sub-classification of South Asians [11]. We aim to identify the 10-year incidence (2006–2016) of CHD in South Asians, as compared to other racial-ethnic groups, in a contemporary cohort, using the KPNC integrated health care system, and, understand whether variations in CHD incidence can be explained by traditional ASCVD risk factors.
Ethnic differences in cardiometabolic risk among adolescents across the waist–height ratio spectrum: National Health and Nutrition Examination Surveys (NHANES)
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Contemporary reevaluation of race and ethnicity with outcomes in heart failure
2021, Journal of the American Heart Association