A cohort study: temporal trends in prevalence of antecedents, comorbidities and mortality in Aboriginal and non-Aboriginal Australians with first heart failure hospitalization, 2000-2009.
OBJECTIVE
Little is known about trends in risk factors and mortality for Aboriginal Australians with heart failure (HF). This population-based study evaluated trends in prevalence of risk factors, 30-day and 1-year all-cause mortality following first HF hospitalization among Aboriginal and non-Aboriginal Western Australians in the decade 2000-2009.


METHODS
Linked-health data were used to identify patients (20-84 years), with a first-ever HF hospitalization. Trends in demographics, comorbidities, interventions and risk factors were evaluated. Logistic and Cox regression models were fitted to test and compare trends over time in 30-day and 1-year mortality.


RESULTS
Of 17,379 HF patients, 1,013 (5.8%) were Aboriginal. Compared with 2000-2002, the prevalence (as history) of myocardial infarction and hypertension increased more markedly in 2006-2009 in Aboriginal (versus non-Aboriginal) patients, while diabetes and chronic kidney disease remained disproportionately higher in Aboriginal patients. Risk factor trends, including the Charlson comorbidity index, increased over time in younger Aboriginal patients. Risk-adjusted 30-day mortality did not change over the decade in either group. Risk-adjusted 1-year mortality (in 30-day survivors) was non-significantly higher in Aboriginal patients in 2006-2008 compared with 2000-2002 (hazard ratio (HR) 1.44; 95% CI 0.85-2.41; p-trend = 0.47) whereas it decreased in non-Aboriginal patients (HR 0.87; 95% CI 0.78-0.97; p-trend = 0.01).


CONCLUSIONS
Between 2000 and 2009, the prevalence of HF antecedents increased and remained disproportionately higher in Aboriginal (versus non-Aboriginal) HF patients. Risk-adjusted 1-year mortality did not improve in Aboriginal patients over the period in contrast with non-Aboriginal patients. These findings highlight the need for better prevention and post-HF care in Aboriginal Australians.
Western Australian Centre for Rural Health, University of Western Australia (UWA), Perth, Australia. katherine.teng@uwa.edu.au.
Tiew-Hwa Katherine
TH
Teng
Western Australian Centre for Rural Health, University of Western Australia (UWA), Perth, Australia.
Judith M
JM
Katzenellenbogen
School of Medicine & Pharmacology, Sir Charles Gairdner Hospital Unit, UWA, Perth, Australia.
Joseph
J
Hung
School of Population Health, UWA, Perth, Australia.
Matthew
M
Knuiman
School of Population Health, UWA, Perth, Australia.
Frank M
FM
Sanfilippo
School of Population Health, UWA, Perth, Australia.
Elizabeth
E
Geelhoed
Centre for Aboriginal Medical and Dental Health, UWA, Perth, Australia.
Dawn
D
Bessarab
School of Population Health, UWA, Perth, Australia.
Michael
M
Hobbs
Western Australian Centre for Rural Health, University of Western Australia (UWA), Perth, Australia.
Sandra C
SC
Thompson
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology / Q000208:ethnology; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors