title: Atrial fibrillation incidence and risk factors in relation to race-ethnicity and the population attributable fraction of atrial fibrillation risk factors: the Multi-Ethnic Study of Atherosclerosis.
abstract: OBJECTIVE
  We studied incident atrial fibrillation (AF) in the prospective community-based Multi-Ethnic Study of Atherosclerosis (MESA). Reportedly, non-Hispanic blacks (NHBs) have a lower AF burden compared with their non-Hispanic white (NHW) counterparts. Information on the epidemiology of AF in Hispanic and Asian populations is much more limited.
  
  
  METHODS
  We excluded participants with a history of AF at enrollment. A total of 6721 MESA participants were monitored for the first AF event ascertained according to hospital discharge International Classification of Diseases, Ninth Revision, codes. Age- and sex-adjusted incidence rates (IRs) of AF were calculated per 1000 person-years of observation. IR ratios were calculated using NHWs as the reference group. Age- and sex-adjusted population attributable fractions (PAFs) of established modifiable AF risk factors were ascertained.
  
  
  RESULTS
  In the MESA cohort, 47.2% was male; at baseline, 25.7% had hypertension; 12.5% had diabetes. Three hundred five incident hospitalized AF events occurred over a mean follow-up of 7.3 years. Age- and sex-adjusted IRs and IR ratios showed that overall AF incidence was significantly lower among Hispanics, NHBs and Chinese compared with NHWs (all P < .001). Among participants 65 years of age or greater, Hispanics, Chinese, and blacks had significantly lower AF incidence than NHWs (all P ≤ .01), but IRs were similar among participants under age 65 years. The PAF for smoking was 27% among NHBs but lower among other race-ethnic groups. Among NHWs, the PAF for hypertension was 22.2%, but this was higher among NHBs (33.1%), Chinese (46.3%), and Hispanics (43.9%).
  
  
  CONCLUSIONS
  Overall, the incidence of hospitalized AF was significantly lower in Hispanics, NHBs, and Chinese than in NHWs. A larger proportion of AF events appear to be attributable to hypertension among nonwhite populations compared with NHWs.
authors.affiliation: Department of Medicine, Wake Forest University School of Medicine, Winston Salem, NC; Department of Epidemiology & Prevention, Wake Forest University School of Medicine, Winston Salem, NC. Electronic address: crodrigu@wakehealth.edu.
authors.forename: Carlos J
authors.initials: CJ
authors.lastname: Rodriguez
authors.affiliation: Department of Medicine, Wake Forest University School of Medicine, Winston Salem, NC; Department of Epidemiology & Prevention, Wake Forest University School of Medicine, Winston Salem, NC.
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Alonso
authors.affiliation: Department of Medicine, Wake Forest University School of Medicine, Winston Salem, NC; Department of Epidemiology & Prevention, Wake Forest University School of Medicine, Winston Salem, NC.
authors.forename: Katrina
authors.initials: K
authors.lastname: Swett
authors.affiliation: Department of Medicine, Weill-Cornell School of Medicine, New York, NY.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Okin
authors.affiliation: Department of Epidemiology, Colorado School of Public Health, Aurora.
authors.forename: David C
authors.initials: DC
authors.lastname: Goff
authors.affiliation: Department of Epidemiology, University of Washington.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Heckbert
mesh_terms: D001741:Black or African American; D000367:Age Factors; D001213:Asian; D001281:Atrial Fibrillation / Q000208:ethnology*; D002681:China / Q000208:ethnology; D003920:Diabetes Mellitus / Q000208:ethnology; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D015438:Health Behavior / Q000208:ethnology; D006630:Hispanic or Latino; D006801:Humans; D006973:Hypertension / Q000208:ethnology; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D009765:Obesity / Q000208:ethnology; D011446:Prospective Studies; D044469:Racial Groups / Q000706:statistics & numerical data*; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000208:ethnology; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
keywords: Atrial fibrillation; Chinese; Hispanics; epidemiology