Socioeconomic status and the development of atrial fibrillation in Hispanics, African Americans and non-Hispanic whites

Eric Shulman, Faraj Kargoli, Philip Aagaard, Ethan Hoch, Luigi Di Biase, John Fisher, Jay Gross, Soo Kim, Kevin J. Ferrick, Andrew Krumerman

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background: Atrial fibrillation (AF) is the most common arrhythmia and is associated with significant morbidity and mortality. Despite having a higher burden of traditional AF risk factors, African American and Hispanic minorities have a lower incidence of AF when compared to non-Hispanic whites, referred to as the “racial paradox.”. Hypothesis: Lower SES among Hispanics and African Americans may help to explain the lower incidence rates of AF compared to non-Hispanic whites. Methods: An electrocardiogram/electronic medical records database in New York State was interrogated for individuals free of AF for development of subsequent AF from 2000 to 2013. SES was assessed per zip code via a composite of 6 measures Z-scored to the New York State average. SES was reclassified into decile groups. Cox regression analysis controlling for all baseline differences was used to estimate the independent predictive ability of SES for AF. Results: We identified 48 631 persons (43% Hispanic, 37% African Americans, and 20% non-Hispanic white; mean age 59 years; mean follow-up of 3.2 years) of which 4556 AF cases occurred. Hispanics and African Americans had lower AF risk than whites in all SES deciles (P < 0.001 by log-rank test). Higher SES was borderline associated with lower AF risk (hazard ratio: 0.990, 95% confidence interval: 0.980-1.001, P = 0.061). P trend analysis was not significant by any race/ethnic group by SES deciles for AF. Conclusions: Our study suggests that non-Hispanic whites were at higher risk for AF compared to nonwhites, and this was independent of SES.

Original languageEnglish (US)
Pages (from-to)770-776
Number of pages7
JournalClinical Cardiology
Issue number9
StatePublished - Sep 2017


  • Arrhythmias
  • Atrial Fibrillation
  • Race and Ethnicity
  • Risk Factors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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