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Heart Failure Among Asian American Subpopulations
Yan Cheng1,2, Adrienne N Poon3, Youxuan Ling1
1Department of Clinical Research and Leadership, George Washington University, Washington, DC.
Insights
Heart failure (HF) incidence and prevalence vary significantly among Asian American subgroups. Southeast Asian patients showed higher HF rates, comparable to Black patients, highlighting the need for ethnic-specific risk assessments.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Health Disparities
Background:
- Heart failure (HF) is a major cause of mortality in the United States.
- Existing data on HF burden in Asian American populations, particularly subgroups, is limited and inconsistent.
Purpose of the Study:
- To compare the incidence and prevalence of heart failure (HF) across different Asian American subgroups.
- To identify disparities in HF outcomes among racial and ethnic groups.
Main Methods:
- Retrospective cohort study utilizing electronic health record data from 2015-2019.
- Inclusion of patients aged 40 years or older from over 100 US healthcare systems.
- Analysis of HF incidence and prevalence using ICD codes, standardized for age and sex.
Main Results:
- Significant variations in age- and sex-standardized HF incidence were observed among Asian American subgroups.
- Southeast Asian patients had a higher HF incidence (2.26%) compared to White patients (1.58%), similar to Black patients (2.39%).
- East Asian (1.22%) and South Asian (1.56%) patients also showed distinct HF incidence rates, with heterogeneous prevalence rates noted.
Conclusions:
- Disparities in HF outcomes exist between Asian American subgroups, with Southeast Asians exhibiting rates similar to Black patients.
- Findings underscore the importance of considering individual Asian ethnicities and specific cardiovascular risk factors in HF risk assessment.
- The study highlights the need for tailored public health strategies addressing HF in diverse Asian American communities.
Importance:
Heart failure (HF) is a leading cause of death in the US. The current evidence on the burdens of HF in Asian American populations, especially Asian American subgroups, is limited and inconsistent.
Objective:
To assess and compare the incidence and prevalence of HF in Asian American subgroups.
Design, Setting, And Participants:
This retrospective cohort study used electronic health record data from patients 40 years or older with health care encounters from January 1, 2015, to December 31, 2019, recorded in the Oracle Electronic Health Record Real-World Data database, which has more than 100 health care systems across the US contributing to the database as of February 2024. For prevalence analysis, the study samples were those who had at least 1 encounter in the study calendar year. For incidence analysis, participants were additionally limited to those without HF before the study year who also had encounter(s) the year before the study year. Data analysis was performed from August 1, 2023, to July 31, 2024.
Exposure:
Race and ethnicity were determined using patient self-reported data, which were categorized as Black, East Asian, South Asian, Southeast Asian, other Asian (without specified ethnicity), and White.
Main Outcomes And Measures:
Outcomes were incidence and prevalence of HF, identified using recorded International Classification of Diseases, Ninth Revision, Clinical Modification and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification codes. Age- and sex-standardized incidence and prevalence were used to calculate the risk ratio of each racial and ethnic group compared with White patients.
Results:
Incidence and prevalence analyses were performed for 6 845 791 patients (mean [SD] age, 62.1 [12.5] years; 59.9% female; 2.8% Asian, 6.7% Black, and 90.5% White) and for 13 440 234 patients (mean [SD] age, 61.7 [12.7] years; 57.0% female; 2.9% Asian, 7.1% Black, and 90.0% White), respectively. Using the 2015 population as the standard, age- and sex-standardized HF incidence was 2.26% (95% CI, 2.07%-2.45%) for Southeast Asian patients, 1.56% (95% CI, 1.31%-1.82%) for South Asian patients, and 1.22% (95% CI, 1.06%-1.38%) for East Asian patients compared with 1.58% (95% CI, 1.57%-1.59%) for White patients and 2.39% (95% CI, 2.36%-2.42%) for Black patients. Similarly, heterogeneous rates in Asian American subgroups were also observed in the prevalence analysis.
Conclusions And Relevance:
In this study of HF outcomes, the disparities between Southeast and East Asian patients were larger than those between Black and White patients, with the estimates in Southeast Asian patients being similar to those of Black patients. These findings reinforce that individual Asian ethnicities and cardiovascular risk factors should be considered in the assessment of HF risks.
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