title: Incidence of first heart failure hospitalisation and mortality in Aboriginal and non-Aboriginal patients in Western Australia, 2000-2009.
abstract: OBJECTIVE
  To compare the incidence of first heart failure (HF) hospitalisation, antecedent risk factors and 1-year mortality between Aboriginal and non-Aboriginal populations in Western Australia (2000-2009).
  
  
  METHODS
  A population-based cohort aged 20-84 years comprising Aboriginal (n=1013; mean 54±14 years) and non-Aboriginal patients (n=16,366; mean 71±11 years) with first HF hospitalisation was evaluated. Age and sex-specific incidence rates and HF antecedents were compared between subpopulations. Regression models were used to examine 30-day and 1-year (in 30-day survivors) mortality.
  
  
  RESULTS
  Aboriginal patients were younger, more likely to reside in rural/remote areas (76% vs 23%) and to be women (50.6% vs 41.7%, all p<0.001). Aboriginal (versus non-Aboriginal) HF incidence rates were 11-fold higher in men and 23-fold in women aged 20-39 years, declining to about 2-fold in patients aged 70-84 years. Ischaemic and rheumatic heart diseases were more common antecedents of HF in younger (<55 years) Aboriginal versus non-Aboriginal patients (p<0.001). Hypertension, diabetes, chronic kidney disease, renal failure, chronic obstructive pulmonary disease, and a high Charlson comorbidity index (>=3) were also more prevalent in younger and older Aboriginal patients (p<0.001). Although 30-day mortality was similar in both subpopulations, Aboriginal patients aged<55 years had a 1.9 risk-adjusted hazard ratio (HR) for 1-year mortality (p=0.015).
  
  
  CONCLUSIONS
  Aboriginal people had substantially higher age and sex-specific HF incidence rate and prevalence of HF antecedents than their non-Aboriginal counterparts. HR for 1-year mortality was also significantly worse at younger ages, highlighting the urgent need for enhanced primary and secondary prevention of HF in this population.
authors.affiliation: Combined Universities Centre for Rural Health, University of Western Australia, Australia. Electronic address: katherine.teng@uwa.edu.au.
authors.forename: Tiew-Hwa Katherine
authors.initials: TH
authors.lastname: Teng
authors.affiliation: Combined Universities Centre for Rural Health, University of Western Australia, Australia; School of Population Health, University of Western Australia, Australia.
authors.forename: Judith M
authors.initials: JM
authors.lastname: Katzenellenbogen
authors.affiliation: Combined Universities Centre for Rural Health, University of Western Australia, Australia.
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Thompson
authors.affiliation: School of Population Health, University of Western Australia, Australia.
authors.forename: Frank M
authors.initials: FM
authors.lastname: Sanfilippo
authors.affiliation: School of Population Health, University of Western Australia, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Knuiman
authors.affiliation: School of Population Health, University of Western Australia, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Geelhoed
authors.affiliation: School of Population Health, University of Western Australia, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Hobbs
authors.affiliation: CHIRI-Indigenous, School of Health Sciences, Curtin University, Australia.
authors.forename: Dawn
authors.initials: D
authors.lastname: Bessarab
authors.affiliation: Sir Charles Gairdner Hospital Unit, School of Medicine & Pharmacology, University of Western Australia, Australia.
authors.forename: Joseph
authors.initials: J
authors.lastname: Hung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000191:economics* / Q000208:ethnology*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D012959:Socioeconomic Factors; D014904:Western Australia / Q000208:ethnology; D055815:Young Adult
keywords: Aboriginal; Heart failure; Indigenous; Risk factors; Survival