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Incidence of heart failure among immigrants to Ontario, Canada: a CANHEART immigrant study

Di Giuseppe G, Chu A, Tu JV, Shanmugasegaram S, Liu P, Lee DS. J Card Fail. 2019; 25(6):425-35. Epub 2019 Mar 12. DOI: 10.1016/j.cardfail.2019.03.006.


Background — Several known traditional cardiovascular risk factors contribute to the development of heart failure (HF); however, whether ethnicity is also an important predictor is not well-established. We determined the incidence of hospitalization for HF among ethnic groups in Ontario, Canada and examined differences in risk factor prevalence that may contribute to disparities in HF hospitalization incidence between groups.

Methods and Results — We conducted a retrospective observational study from 2008 to 2012 using a linked cohort derived from population-based health administrative, clinical and survey datasets. We followed 895,823 recent immigrants from 8 ethnic groups and 5.3 million long-term residents, aged 40 to 105 years for incident HF hospitalization. Sex-stratified, age-standardized HF incidence was lower among all immigrant groups than long-term residents. Among immigrants, Black men and West Asian women had the highest incidence of hospitalizations for HF (1.19 and 1.60 per 1000 person-years, respectively), while East Asians of both genders had the lowest incidence. After adjusting for sociodemographic characteristics, co-morbidities and other risk factors, the association between ethnicity and HF hospitalization risk remained significant.

Conclusions — HF hospitalization incidence varies widely amongst ethnic immigrant groups, highlighting the importance of ethnicity as a potential independent risk factor for HF development.

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