Race and Ethnic and Sex Differences in Rhythm Control Treatment of Incident Atrial Fibrillation

Figures & data

Table 1 Baseline Demographics of Patients with Incident Atrial Fibrillation

Variable	Asian Female n=763	Asian Male n=869	Black Female n=3073	Black Male n=2612	Hispanic Female n=2685	Hispanic Male n=2809	White Female n=30,085	White Male n=35,036	P value
Patient (%), (N=77,932)	(1.0)	(1.1)	(3.9)	(3.4)	(3.6)	(3.6)	(38.6)	(45.0)
Age (years), mean (SD)	73.4 (12.1)	70.2 (12.9)	72.1 (12.2)	67.2 (13.4)	73.9 (11.4)	68.4 (14.3)	74.7 (10.3)	69.5 (12.6)	<0.001
Education, n (%)									<0.001
Bachelor’s or higher	184 (24.1)	241 (27.7)	183 (6.0%)	162 (6.2)	264 (9.8)	313 (11.1)	5021 (16.7)	6797 (19.4)
HS or less	139 (18.2)	158 (18.2)	1465 (47.7)	1113 (42.6)	1204 (44.8)	1201 (42.8)	6805 (22.6)	7319 (20.9)
Less than Bachelor’s	435 (57.0)	468 (53.9)	1418 (46.1)	1331 (51.0)	1212 (45.1)	1289 (45.9)	18,185 (60.5)	20,816 (59.4)
Unknown	5 (0.7)	2 (0.2)	7 (0.2)	6 (0.2)	5 (0.2)	6 (0.2)	74 (0.3)	104 (0.3)
Insurance, n (%)									<0.001
HMO/EPO	391 (51.3)	389 (44.8)	1167 (38.0%)	795 (30.4)	1584 (59.0)	1388 (49.4)	10,796 (35.9)	10,521 (30.0)
IND/OTH	234 (30.7)	259 (29.8)	1270 (41.3)	888 (34.0)	637 (23.7)	633 (22.5)	13,120 (43.6)	12,381 (35.3)
POS	114 (14.9)	198 (22.8)	447 (14.6)	732 (28.0)	320 (11.9)	641 (22.8)	4069 (13.5)	9523 (27.2)
PPO	22 (2.9)	22 (2.5)	186 (6.1)	184 (7.0)	139 (5.2)	144 (5.1)	2040 (6.8)	2461 (7.0)
Unknown	2 (0.3)	1 (0.1)	3 (0.1)	13 (0.5)	5 (0.2)	3 (0.1)	60 (0.2)	150 (0.4)
Sleep Apnea	29 (3.8)	63 (7.3)	297 (9.7)	320 (12.3)	196 (7.3)	293 (10.4)	2206 (7.3)	4488 (12.8)	<0.001
CHA2DS2-VASc score, mean (SD)	3.9 (1.7)	2.9 (1.8)	4.3 (1.8)	2.7 (1.8)	4.3 (1.8)	2.8 (1.9)	4.0 (1.7)	2.6 (1.8)	<0.001
Elixhauser Score, mean (SD)	3.3 (2.5)	3.0 (2.4)	4.1 (2.8)	3.4 (2.7)	4.0 (6.7)	3.3 (2.7)	3.4 (2.5)	2.9 (2.4)	<0.001
Provider Region									<0.001
North Central	92 (12.1)	107 (12.3)	660 (21.5%)	530 (20.3)	208 (7.8)	229 (8.2)	9323 (31.0)	11,056 (31.6)
Northeast	120 (15.7)	166 (19.1)	292 (9.5)	223 (8.5)	364 (13.6)	361 (12.9)	3896 (13.0)	4357 (12.4)
South	139 (18.2)	175 (20.1)	1836 (59.8)	1650 (63.2)	955 (35.6)	1118 (39.9)	9068 (30.1)	11,274 (32.2)
West	407 (53.3)	419 (48.2)	280 (9.1)	203 (7.8)	1134 (42.3)	1092 (38.9)	7663 (25.5)	8248 (23.5)
Unknown	5 (0.7)	2 (0.2)	5 (0.2)	6 (0.2)	24 (0.9)	9 (0.3)	135 (0.5)	101 (0.3)

Notes: Data is n (%), unless otherwise noted. CHA₂DS₂-VASc, stroke risk score where “C” represents congestive heart failure history, “H” represents hypertension history, “A” represents age greater than 75 years, “D” represents diabetes history, “S” represents stroke/transient ischemic attack, thromboembolism history, “V” represents vascular disease history, “A” represents age 65–74 years, “S” represents sex category.

Abbreviations: CPD, chronic pulmonary disease; EPO, exclusive provider organization; HMO, health maintenance organization; HS, high school; IND/OTH, indemnity/other; POS, point-of-service; PPO, preferred provider organization; SD, standard deviation.

Figure 1 Sample attrition based on study inclusion and exclusion criteria.

Table 2 Bivariate Analysis Comparing Rhythm Control Treatment for Atrial Fibrillation by Race and Ethnicity and Sex

Outcome	AF-Related Treatment
	Anti-Arrhythmic Drugs*	Cardioversion*	AF Ablation*
	N (%)	N (%)	N (%)
White Male (n=35,036)	8771 (25.0)	6972 (19.9)	1749 (5.0)
White Female (n=30,085)	6658 (22.1)	3807 (12.7)	809 (2.7)
Black Male (n=2612)	623 (23.9)	418 (16.0)	94 (3.6)
Black Female (n=3073)	701 (22.8)	301 (9.8)	76 (2.5)
Asian Male (n=869)	206 (23.7)	103 (11.9)	36 (4.1)
Asian Female (n=763)	152 (19.9)	62 (8.1)	23 (3.0)
Hispanic Male (n=2809)	679 (24.2)	357 (12.7)	108 (3.8)
Hispanic Female (n=2685)	647 (24.1)	233 (8.7)	62 (2.3)

Note: *p-value <0.0001 (from chi-square analysis).

Table 3 Logistic Regression Model Results for Treatment of Incident Atrial Fibrillation by Race and Ethnicity, Sex, and Race and Ethnicity–Sex

Outcome	AF-Related Treatment
	Anti-Arrhythmic Drugs	Cardioversion	AF Ablation
	OR* (95% CI)	OR* (95% CI)	OR* (95% CI)
Race and Ethnicity^a
White (n=65,121)	Reference
Black (n=5685)	0.92 (0.86–0.99)	0.80 (0.73–0.87)	0.80 (0.68–0.94)
Asian (n=1632)	0.94 (0.83–1.06)	0.65 (0.55–0.76)	0.96 (0.74–1.26)
Hispanic (n=5494)	1.03 (0.96–1.10)	0.74 (0.68–0.81)	0.89 (0.76–1.04)
Sex^a
Male (n=41,326)	Reference
Female (n=36,606)	1.07 (1.03–1.11)	0.71 (0.68–0.75)	1.01 (0.93–1.11)
Race and Ethnicity–Sex^b
White Male (n=35,036)	Reference
White Female (n=30,085)	1.04 (1.01–1.09)	0.71 (0.68–0.74)	0.98 (0.90–1.08)
Black Male (n=2612)	0.87 (0.79–0.96)	0.81 (0.72–0.90)	0.72 (0.58–0.90)
Black Female (n=3073)	1.02 (0.93–1.12)	0.56 (0.50–0.77)	0.91 (0.72–1.16)
Asian Male (n=869)	1.00 (0.85–1.18)	0.63 (0.51–0.77)	0.91 (0.64–1.28)
Asian Female (n=763)	0.90 (0.75–1.08)	0.48 (0.37–0.63)	1.06 (0.69–1.62)
Hispanic Male (n=2809)	0.96 (0.88–1.05)	0.71 (0.68–0.74)	0.84 (0.69–1.04)
Hispanic Female (n=2685)	1.17 (1.06–1.28)	0.57 (0.50–0.63)	0.95 (0.73–1.24)

Notes: ^aRegression model wherein race and ethnicity and sex were the main independent variables of interest adjusting for study covariates. ^bRegression model wherein a variable combining race and ethnicity and sex was used as the main independent variable of interest adjusting for study covariates. *Risk models adjusted for: age, education, insurance, Elixhauser comorbidity score, CHA₂DS₂-VASc score, sleep apnea, and provider region.

Abbreviations: AF, atrial fibrillation; OR, odds ratio; CI, confidence interval.