Cardiovascular multimorbidity: the effect of ethnicity on prevalence and risk factor management
Rohini Mathur1, Sally A Hull, Ellena Badrick
1Centre for Health Sciences, Queen Mary University of London, London, UK. r.mathu@qmul.ac.uk
Insights
Cardiovascular multimorbidity is more prevalent in non-white ethnic groups. While risk factor management improves with more conditions, ethnic disparities persist, contributing to health inequalities.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Multimorbidity, particularly cardiovascular disease, is prevalent in primary care.
- Recognized ethnic variations exist in cardiovascular disease prevalence and risk factor management.
Purpose of the Study:
- To assess the population burden of cardiovascular multimorbidity.
- To examine modifiable cardiovascular risk factor management across different ethnicities.
Main Methods:
- Cross-sectional study of 843,720 individuals across 148 general practices in East London.
- Utilized MIQUEST data from cardiovascular registers; employed logistic regression for multimorbidity risk and risk factor control analysis by ethnicity.
Main Results:
- Crude prevalence of cardiovascular multimorbidity was 34%.
- Non-white ethnic groups showed higher multimorbidity risk (South Asians OR 2.04, Black ethnicity OR 1.23).
- Risk factor control (blood pressure, cholesterol, HbA1c) improved with multimorbidity, but ethnic differences persisted.
Conclusions:
- Cardiovascular multimorbidity burden and risk factor management vary significantly by ethnicity.
- Despite improvements with higher morbidity, persistent ethnic disparities in risk factor control contribute to health inequalities.
Background:
Multimorbidity is common in primary care populations. Within cardiovascular disease, important differences in disease prevalence and risk factor management by ethnicity are recognised.
Aim:
To examine the population burden of cardiovascular multimorbidity and the management of modifiable risk factors by ethnicity.
Design And Setting:
Cross-sectional study of general practices (148/151) in the east London primary care trusts of Tower Hamlets, City and Hackney, and Newham, with a total population size of 843 720.
Method:
Using MIQUEST, patient data were extracted from five cardiovascular registers. Logistic regression analysis was used to examine the risk of being multimorbid by ethnic group, and the control of risk factors by ethnicity and burden of cardiovascular multimorbidity.
Results:
The crude prevalence of cardiovascular multimorbidity among patients with at least one cardiovascular condition was 34%. People of non-white ethnicity are more likely to be multimorbid than groups of white ethnicity, with adjusted odds ratios of 2.04 (95% confidence interval [CI] = 1.94 to 2.15) for South Asians and 1.23 (95% CI = 1.18 to 1.29) for groups of black ethnicity. Achievement of targets for blood pressure, cholesterol, and glycated haemoglobin (HbA(1c)) was higher for patients who were multimorbid than unimorbid. For cholesterol and blood pressure, South Asian patients achieved better control than those of white and black ethnicity. For HbA(1c) levels, patients of white ethnicity had an advantage over other groups as the morbidity burden increased.
Conclusion:
The burden of multiple disease varies by ethnicity. Risk factor management improves with increasing levels of cardiovascular multimorbidity, but clinically important differences by ethnicity remain and contribute to health inequalities.
Related Concept Videos
01:26Atherosclerosis III: Management
01:30Coronary Artery Disease I: Introduction
01:26Coronary Artery Disease IV: Preventive Measures
01:21Rheumatic Heart Disease III: Medical Management
01:29Cardiomyopathy V: Interprofessional Care
01:29Pharmacogenetic Phenotypes: Alterations in Pharmacokinetics, Drug Targets and Biologic Milieu