Racial Differences in Bleeding Risk: An Ecological Epidemiological Study Comparing Korea and United Kingdom Subjects

Abstract

Background: This study aimed to evaluate racial differences in bleeding incidence by conducting an ecological epidemiological study using data from Korea and the UK. Methods: We included healthy participants from the Korean National Health Insurance Service-Health Screening and the UK Biobank who underwent health examinations between 2006 and 2010 and had no comorbidities or history of medication use. Finally, 112,750 East Asians (50.7% men, mean age 52.6 years) and 210,995 Caucasians (44.7% men, mean age 55.0 years) were analyzed. The primary outcome was composed of intracranial hemorrhage (ICH) and bleeding from the gastrointestinal, respiratory, and genitourinary systems. Results: During the follow-up, primary outcome events occurred in 2110 East Asians and in 6515 Caucasians. East Asians had a 38% lower five-year incidence rate compared to Caucasians (3.88 vs. 6.29 per 1000 person-years; incidence rate ratio [IRR] 0.62, 95% confidence interval [CI] 0.59–0.65). East Asians showed a lower incidence of major bleeding (IRR 0.86, 95% CI 0.81–0.91), bleeding from the gastrointestinal (IRR 0.53, 95% CI 0.49–0.56), and genitourinary systems (IRR 0.49, 95% CI 0.44–0.53) compared to Caucasians. The incidence rates of ICH (IRR 3.20, 95% CI 2.67–3.84) and bleeding from the respiratory system (IRR 1.28, 95% CI 1.11–1.47) were higher in East Asians. East Asians consuming alcohol ≥3 times/week showed a higher incidence of the primary outcome than Caucasians (IRR 1.12, 95% CI 1.01–1.25). Conclusions: This ecological study revealed significant racial differences in bleeding incidence, influenced by anatomical sites and lifestyle habits, underscoring the need for race-specific holistic approaches in bleeding management.

Comparing the Real-World and Clinical Trial Bleeding Rates Associated with Oral Anticoagulation Treatment for Atrial Fibrillation

“…CT data included patients from over 100 countries, whereas RWD are only from the US. Previous studies have shown ethnic and racial differences in bleeding complications associated with DOACs [38,39], and hence, the population/ethnic differences could have impacted the results seen in our study, given ethic differences in stroke and bleeing rates [40][41][42].…”

2024 Chinese Expert Consensus Guidelines on the Diagnosis and Treatment of Atrial Fibrillation in the Elderly, Endorsed by Geriatric Society of Chinese Medical Association (Cardiovascular Group) and Chinese Society of Geriatric Health Medicine (Cardiovascular Branch): Executive Summary

“…12 Some evidence suggests that Asian patients are more sensitive to anticoagulation, in terms of bleeding, 13,14 but ethnic differences in thromboembolism and intracranial bleeding are evident. 15,16…”

Educational Attainment, Obesity, and Venous Thromboembolism. Is Only Matter of Weight?

“…The impact of associated metabolic comorbidities and their changes over time (risk being dynamic rather than a static measure) also require consideration. Given the racial and sex differences in thrombotic (and bleeding) outcomes, 17,18 the picture is very likely to be far more complex.…”