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      Trends in Acute Myocardial Infarction by Race and Ethnicity

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          Abstract

          Background

          Trends in acute myocardial infarction (AMI) incidence rates for diverse races/ethnicities are largely unknown, presenting barriers to understanding the role of race/ethnicity in AMI occurrence.

          Methods and Results

          We identified AMI hospitalizations for Kaiser Permanente Southern California members, aged ≥35 years, during 2000 to 2014 using discharge diagnostic codes. We excluded hospitalizations with missing race/ethnicity information. We calculated annual incidence rates (age and sex standardized to the 2010 US census population) for AMI, ST‐segment–elevation myocardial infarction, and non–ST‐segment–elevation myocardial infarction by race/ethnicity (Hispanic and non‐Hispanic racial groups: Asian or Pacific Islander, black, and white). Using Poisson regression, we estimated annual percentage change in AMI, non–ST‐segment–elevation myocardial infarction, and ST‐segment–elevation myocardial infarction incidence by race/ethnicity and AMI incidence rate ratios between race/ethnicity pairs, adjusting for age and sex. We included 18 630 776 person‐years of observation and identified 44 142 AMI hospitalizations. During 2000 to 2014, declines in AMI, non–ST‐segment–elevation myocardial infarction, and ST‐segment–elevation myocardial infarction were 48.7%, 34.2%, and 69.8%, respectively. Age‐ and sex‐standardized AMI hospitalization rates/100 000 person‐years declined for Hispanics (from 307 to 162), Asians or Pacific Islanders (from 271 to 158), blacks (from 347 to 199), and whites (from 376 to 189). Annual percentage changes ranged from −2.99% to −4.75%, except for blacks, whose annual percentage change was −5.32% during 2000 to 2009 and −1.03% during 2010 to 2014.

          Conclusions

          During 2000 to 2014, AMI, non–ST‐segment–elevation myocardial infarction, and ST‐segment–elevation myocardial infarction hospitalization incidence rates declined substantially for each race/ethnic group. Despite narrowing rates among races/ethnicities, differences persist. Understanding these differences can help identify unmet needs in AMI prevention and management to guide targeted interventions.

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          Most cited references23

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          Twenty-two-year trends in incidence of myocardial infarction, coronary heart disease mortality, and case fatality in 4 US communities, 1987-2008.

          Knowledge of trends in the incidence of and survival after myocardial infarction (MI) in a community setting is important to understanding trends in coronary heart disease (CHD) mortality rates. We estimated race- and gender-specific trends in the incidence of hospitalized MI, case fatality, and CHD mortality from community-wide surveillance and validation of hospital discharges and of in- and out-of-hospital deaths among 35- to 74-year-old residents of 4 communities in the Atherosclerosis Risk in Communities (ARIC) Study. Biomarker adjustment accounted for change from reliance on cardiac enzymes to widespread use of troponin measurements over time. During 1987-2008, a total of 30 985 fatal or nonfatal hospitalized acute MI events occurred. Rates of CHD death among persons without a history of MI fell an average 4.7%/y among men and 4.3%/y among women. Rates of both in- and out-of-hospital CHD death declined significantly throughout the period. Age- and biomarker-adjusted average annual rate of incident MI decreased 4.3% among white men, 3.8% among white women, 3.4% among black women, and 1.5% among black men. Declines in CHD mortality and MI incidence were greater in the second decade (1997-2008). Failure to account for biomarker shift would have masked declines in incidence, particularly among blacks. Age-adjusted 28-day case fatality after hospitalized MI declined 3.5%/y among white men, 3.6%/y among black men, 3.0%/y among white women, and 2.6%/y among black women. Although these findings from 4 communities may not be directly generalizable to blacks and whites in the entire United States, we observed significant declines in MI incidence, primarily as a result of downward trends in rates between 1997 and 2008.
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            Trends in hospitalizations and outcomes for acute cardiovascular disease and stroke, 1999-2011.

            During the past decade, efforts focused intensely on improving the quality of care for people with, or at risk for, cardiovascular disease and stroke. We sought to quantify the changes in hospitalization rates and outcomes during this period.
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              Call to action: cardiovascular disease in Asian Americans: a science advisory from the American Heart Association.

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                Author and article information

                Contributors
                kristi.reynolds@kp.org
                Journal
                J Am Heart Assoc
                J Am Heart Assoc
                10.1002/(ISSN)2047-9980
                JAH3
                ahaoa
                Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
                John Wiley and Sons Inc. (Hoboken )
                2047-9980
                02 March 2020
                03 March 2020
                : 9
                : 5 ( doiID: 10.1002/jah3.v9.5 )
                : e013542
                Affiliations
                [ 1 ] Epidemic Intelligence Service Division of Scientific Education and Professional Development Centers for Disease Control and Prevention Atlanta GA
                [ 2 ] Department of Research and Evaluation Kaiser Permanente Southern California Pasadena CA
                [ 3 ] Southern California Permanente Medical Group Pasadena CA
                [ 4 ] West Los Angeles Medical Center Los Angeles CA
                [ 5 ] San Diego Medical Center San Diego CA
                [ 6 ] Department of Clinical Science Kaiser Permanente School of Medicine Pasadena CA
                [ 7 ] Amgen Inc Thousand Oaks CA
                Author notes
                [*] [* ] Correspondence to: Kristi Reynolds, PhD, MPH, Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, Floor 2, Pasadena, CA 91101. E‐mail: kristi.reynolds@ 123456kp.org
                Article
                JAH34874
                10.1161/JAHA.119.013542
                7335574
                32114888
                b7b48283-e591-45c4-adf2-2b67e665e041
                © 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 10 June 2019
                : 17 January 2020
                Page count
                Figures: 3, Tables: 2, Pages: 10, Words: 6715
                Funding
                Funded by: Southern California Permanente Medical Group
                Categories
                Original Research
                Original Research
                Epidemiology
                Custom metadata
                2.0
                03 March 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.8 mode:remove_FC converted:23.03.2020

                Cardiovascular Medicine
                acute myocardial infarction,cardiovascular disease,incidence rates,race/ethnicity,trends,epidemiology,myocardial infarction,race and ethnicity

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