Sex and ethnicity modified high 1-year mortality in patients in Singapore with newly diagnosed atrial fibrillation

Abstract

Introduction: We investigated sex and ethnic differences in the incidence, clinical characteristics and 1-year mortality of patients with newly diagnosed AF in a multi-ethnic population. Method: This retrospective cohort study of patients diagnosed with AF from 2008 to 2015 was based on medical claims, casemix and subvention data submitted to the Ministry of Health. Patients with AF were matched with controls without AF for age (3-year bands), sex and ethnicity, and categorised as middle-aged (45–64 years) or elderly (≥65 years) among major ethnic groups in Singapore (Chinese, Malay and Indian). Results: Among 40,602 adults with AF (elderly 74%), Malays had the highest age-standardised incidence rate of AF, followed by Chinese and Indians; and the rate was higher in men. Despite having the worst cardiovascular risk profile, Indians had the lowest prevalence and incidence of AF. The 1-year mortality rate after newly diagnosed AF was 22–26 deaths per 100 people. Newly diagnosed AF was independently associated with increased 1-year all-cause mortality among middle-aged (adjusted odds ratio [AOR] 9.08, 95% confidence interval [CI] 7.36–11.20) and elderly adults (AOR 3.60, 95% CI 3.40–3.80) compared with those without AF. Sex differences in mortality among patients with AF were limited to elderly adults (men: AOR 1.17, 95% CI 1.11–1.24), while Indians were associated with a 30% increased odds of mortality compared with Chinese regardless of age (middle-aged: AOR 1.27, 95% CI 1.09–1.548 elderly: AOR 1.33, 95% CI 1.22–1.45). Conclusion: Variations in incidence, clinical profile and 1-year mortality of patients with AF in a nationwide cohort were influenced by sex and ethnicity. Newly diagnosed AF portends a worse prognosis and is a marker of high mortality within the first year. Keywords: Atrial fibrillation, ethnic differences, one-year mortality, sex differences

Global, regional, and national burdens of atrial fibrillation/flutter from 1990 to 2019: An age-period-cohort analysis using the Global Burden of Disease 2019 study

“…Nonetheless, based on the APC model, we found a greater downward trend or smaller upward trend of AF/AFL-related deaths among women across SDI quintiles, except for low-and high-SDI countries, indicating that the focus on women's health has been effective over the past few decades. In a national study in Singapore, men had 17% increased odds of mortality compared to women one year after a diagnosis of AF/ AFL [22]. The high level of inclusive medical care in countries with a high SDI and the low-quality medical care in countries with a low SDI contributed to sex-homogeneous treatment results.…”

Different strokes for different folks

“…5 In this issue of the Annals, Tan et al had taken further steps to illustrate the interesting differences in the mortality and incidences in multiethnic Singapore. 6 Albeit the study was retrospective in nature with its limitations and potential unknown confounding variables, the authors ought to be commended on several pertinent observations. Firstly, the study was consistent with the huge prospective observational study, Global Anticoagulant Registry in the Field (GARFIELD-AF) 7 and demonstrated incremental mortality among newly diagnosed AF patients belonging to the 3 main ethnic groups (Chinese, Malays and Indians) in Singapore.…”