Racial and Urban-Rural Difference in the Frequency of Ischemic Stroke as Initial Manifestation of Atrial Fibrillation

Objective: Atrial fibrillation (AF) may remain undiagnosed until the development of complications. We aimed to examine the epidemiology and racial/ethnic and rural/urban differences in the frequency of newly diagnosed AF manifesting as ischemic stroke in a nationally representative sample of Medicar...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Jingchuan Guo, Nico Gabriel, Jared W. Magnani, Utibe R. Essien, Walid F. Gellad, Maria M. Brooks, Ludovic Trinquart, Emelia J. Benjamin, Inmaculada Hernandez
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	atrial fibrillation ischemic stroke racial differences urban/rural Medicare claims Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/8a909ff7f57645b5bed50b5c65a7013f
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:8a909ff7f57645b5bed50b5c65a7013f
record_format	dspace
spelling	oai:doaj.org-article:8a909ff7f57645b5bed50b5c65a7013f2021-11-05T06:19:49ZRacial and Urban-Rural Difference in the Frequency of Ischemic Stroke as Initial Manifestation of Atrial Fibrillation2296-256510.3389/fpubh.2021.780185https://doaj.org/article/8a909ff7f57645b5bed50b5c65a7013f2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fpubh.2021.780185/fullhttps://doaj.org/toc/2296-2565Objective: Atrial fibrillation (AF) may remain undiagnosed until the development of complications. We aimed to examine the epidemiology and racial/ethnic and rural/urban differences in the frequency of newly diagnosed AF manifesting as ischemic stroke in a nationally representative sample of Medicare beneficiaries.Methods: We used a 5% random sample of Medicare claims to identify patients newly diagnosed with AF in 2016. The primary dependent variable was stroke or transient ischemic attack (TIA) in the 7 days prior to the first AF diagnosis, i.e., stroke or TIA as the initial manifestation of AF. We constructed a multivariable logistic regression to quantify the association between race/ethnicity, urban/rural residence, and the primary dependent variable.Results: Among 39,409 patients newly diagnosed with AF (mean age 77 ± 10 years; 58% women; 7.2% Black, 87.8% White, 5.1% others), 2,819 (7.2%) had ischemic stroke or TIA in the 7 days prior to AF diagnosis. Black patients (adjusted OR [95% CI]: 1.21 [1.05, 1.40], vs. White) and urban residents (1.21 [1.08, 1.35], vs. rural) were at increased risk of stroke as the initial manifestation of AF. Racial differences were larger among patients aged ≥75 years, with adjusted ORs of 1.43 (1.19, 1.73) for Black vs. White patients, but non-significant for those aged <75 (P for interaction = 0.03).Conclusion: We observed significant and important differences in the risk of stroke as initial manifestation of AF between White and Black patients and between rural and urban residents. Our results suggest potential disparities in the identification AF across race/ethnicity groups and urban/rural areas.Jingchuan GuoJingchuan GuoJingchuan GuoNico GabrielJared W. MagnaniUtibe R. EssienUtibe R. EssienWalid F. GelladWalid F. GelladMaria M. BrooksLudovic TrinquartEmelia J. BenjaminInmaculada HernandezInmaculada HernandezFrontiers Media S.A.articleatrial fibrillationischemic strokeracial differencesurban/ruralMedicare claimsPublic aspects of medicineRA1-1270ENFrontiers in Public Health, Vol 9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	atrial fibrillation ischemic stroke racial differences urban/rural Medicare claims Public aspects of medicine RA1-1270
spellingShingle	atrial fibrillation ischemic stroke racial differences urban/rural Medicare claims Public aspects of medicine RA1-1270 Jingchuan Guo Jingchuan Guo Jingchuan Guo Nico Gabriel Jared W. Magnani Utibe R. Essien Utibe R. Essien Walid F. Gellad Walid F. Gellad Maria M. Brooks Ludovic Trinquart Emelia J. Benjamin Inmaculada Hernandez Inmaculada Hernandez Racial and Urban-Rural Difference in the Frequency of Ischemic Stroke as Initial Manifestation of Atrial Fibrillation
description	Objective: Atrial fibrillation (AF) may remain undiagnosed until the development of complications. We aimed to examine the epidemiology and racial/ethnic and rural/urban differences in the frequency of newly diagnosed AF manifesting as ischemic stroke in a nationally representative sample of Medicare beneficiaries.Methods: We used a 5% random sample of Medicare claims to identify patients newly diagnosed with AF in 2016. The primary dependent variable was stroke or transient ischemic attack (TIA) in the 7 days prior to the first AF diagnosis, i.e., stroke or TIA as the initial manifestation of AF. We constructed a multivariable logistic regression to quantify the association between race/ethnicity, urban/rural residence, and the primary dependent variable.Results: Among 39,409 patients newly diagnosed with AF (mean age 77 ± 10 years; 58% women; 7.2% Black, 87.8% White, 5.1% others), 2,819 (7.2%) had ischemic stroke or TIA in the 7 days prior to AF diagnosis. Black patients (adjusted OR [95% CI]: 1.21 [1.05, 1.40], vs. White) and urban residents (1.21 [1.08, 1.35], vs. rural) were at increased risk of stroke as the initial manifestation of AF. Racial differences were larger among patients aged ≥75 years, with adjusted ORs of 1.43 (1.19, 1.73) for Black vs. White patients, but non-significant for those aged <75 (P for interaction = 0.03).Conclusion: We observed significant and important differences in the risk of stroke as initial manifestation of AF between White and Black patients and between rural and urban residents. Our results suggest potential disparities in the identification AF across race/ethnicity groups and urban/rural areas.
format	article
author	Jingchuan Guo Jingchuan Guo Jingchuan Guo Nico Gabriel Jared W. Magnani Utibe R. Essien Utibe R. Essien Walid F. Gellad Walid F. Gellad Maria M. Brooks Ludovic Trinquart Emelia J. Benjamin Inmaculada Hernandez Inmaculada Hernandez
author_facet	Jingchuan Guo Jingchuan Guo Jingchuan Guo Nico Gabriel Jared W. Magnani Utibe R. Essien Utibe R. Essien Walid F. Gellad Walid F. Gellad Maria M. Brooks Ludovic Trinquart Emelia J. Benjamin Inmaculada Hernandez Inmaculada Hernandez
author_sort	Jingchuan Guo
title	Racial and Urban-Rural Difference in the Frequency of Ischemic Stroke as Initial Manifestation of Atrial Fibrillation
title_short	Racial and Urban-Rural Difference in the Frequency of Ischemic Stroke as Initial Manifestation of Atrial Fibrillation
title_full	Racial and Urban-Rural Difference in the Frequency of Ischemic Stroke as Initial Manifestation of Atrial Fibrillation
title_fullStr	Racial and Urban-Rural Difference in the Frequency of Ischemic Stroke as Initial Manifestation of Atrial Fibrillation
title_full_unstemmed	Racial and Urban-Rural Difference in the Frequency of Ischemic Stroke as Initial Manifestation of Atrial Fibrillation
title_sort	racial and urban-rural difference in the frequency of ischemic stroke as initial manifestation of atrial fibrillation
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/8a909ff7f57645b5bed50b5c65a7013f
work_keys_str_mv	AT jingchuanguo racialandurbanruraldifferenceinthefrequencyofischemicstrokeasinitialmanifestationofatrialfibrillation AT jingchuanguo racialandurbanruraldifferenceinthefrequencyofischemicstrokeasinitialmanifestationofatrialfibrillation AT jingchuanguo racialandurbanruraldifferenceinthefrequencyofischemicstrokeasinitialmanifestationofatrialfibrillation AT nicogabriel racialandurbanruraldifferenceinthefrequencyofischemicstrokeasinitialmanifestationofatrialfibrillation AT jaredwmagnani racialandurbanruraldifferenceinthefrequencyofischemicstrokeasinitialmanifestationofatrialfibrillation AT utiberessien racialandurbanruraldifferenceinthefrequencyofischemicstrokeasinitialmanifestationofatrialfibrillation AT utiberessien racialandurbanruraldifferenceinthefrequencyofischemicstrokeasinitialmanifestationofatrialfibrillation AT walidfgellad racialandurbanruraldifferenceinthefrequencyofischemicstrokeasinitialmanifestationofatrialfibrillation AT walidfgellad racialandurbanruraldifferenceinthefrequencyofischemicstrokeasinitialmanifestationofatrialfibrillation AT mariambrooks racialandurbanruraldifferenceinthefrequencyofischemicstrokeasinitialmanifestationofatrialfibrillation AT ludovictrinquart racialandurbanruraldifferenceinthefrequencyofischemicstrokeasinitialmanifestationofatrialfibrillation AT emeliajbenjamin racialandurbanruraldifferenceinthefrequencyofischemicstrokeasinitialmanifestationofatrialfibrillation AT inmaculadahernandez racialandurbanruraldifferenceinthefrequencyofischemicstrokeasinitialmanifestationofatrialfibrillation AT inmaculadahernandez racialandurbanruraldifferenceinthefrequencyofischemicstrokeasinitialmanifestationofatrialfibrillation
_version_	1718444481512996864

Racial and Urban-Rural Difference in the Frequency of Ischemic Stroke as Initial Manifestation of Atrial Fibrillation

Ejemplares similares