Incidence of Cardiovascular Disease in a Primary Care Population of Young Adults by Disaggregated Race and Ethnicity

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death in the United States, with well-documented racial and ethnic disparities. Data are limited on incidence among patients aged <50 years, particularly within disaggregated Asian and Hispanic subgroups and individuals identifying with multiple racial or ethnic groups. We estimated CVD incidence rates for these groups and assessed whether disparities are explained by other clinical and demographic risk factors. METHODS: This retrospective cohort study used Sutter Health Electronic Health Record data (2010-2024) for adults aged 18 to 49 years with at least 2 primary care visits and a 2-year observed baseline period free of CVD. Incident CVD was defined as myocardial infarction, stroke, or heart failure. We estimated incidence rates, applied age and sex standardization, and fit Cox proportional hazards models adjusting for additional risk factors. RESULTS: In a cohort of 1 178 551 patients, incidence was 1.14 cases per 1000 person-years (95% CI, 1.12-1.17). After standardization, Pacific Islander individuals (hazard ratio [HR], 2.90 [95% CI, 2.29-3.52]) and non-Hispanic Black individuals (HR, 2.82 [95% CI, 2.58-3.06]) had the highest incidence. Within the Asian group, Filipino individuals had the highest incidence (HR, 1.60 [95% CI, 1.42-1.79]). Hispanic subgroups showed less heterogeneity. Elevated HRs persisted among some groups after adjustment with Cox models. CONCLUSIONS: Young adult CVD incidence varied across racial and ethnic subgroups. Elevated risk persisted in several groups after adjustment, consistent with the influence of unmeasured social drivers. These findings support collection of granular racial and ethnic data and validation of existing risk prediction tools in young adult subgroups.