Ethnic differences in 1-year mortality among patients hospitalised with heart failure

OBJECTIVE: The incidence of cardiovascular disease and the prevalence of risk factors have been shown to differ significantly across ethnic groups. The objective of this study was to examine the impact of ethnicity on 1-year mortality among patients with heart failure in a single payer healthcare system with universal access. DESIGN, SETTING AND PATIENTS: Alberta residents aged 20 years or older hospitalised with heart failure between 1 April 1999 and 31 December 2005 are included. Previously validated algorithms were used to assign ethnicity based on patient surname. Patients were categorised as white, Chinese or East Indian. MAIN OUTCOME MEASURE: One-year mortality after adjusting for baseline differences. RESULTS: 52 980 white, 851 Chinese, and 377 East Indian individuals were hospitalised with heart failure. Chinese patients were the oldest and had the highest rates of renal disease. East Indian patients were the youngest and had the highest rates of ischaemic heart disease and diabetes. One-year mortality rates were 31.0% among white patients, 38.7% among Chinese and 26.5% among East Indian patients (p<0.01). Adjusted HR (and 95% CI) for 1-year mortality among Chinese compared with white patients was 1.34 (1.20 to 1.49) and among East Indian compared with white patients it was 1.04 (0.85 to 1.27). These findings were consistent across various subgroups, including patients with incident heart failure. CONCLUSIONS: Ethnicity appears to modulate patient outcomes in heart failure. Chinese patients have significantly higher 1-year mortality rates compared with white patients; there appear to be no differences in mortality among East Indian and white patients.