Date of Award

Spring 5-11-2018

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

First Advisor

Dr. Ike Okosun

Second Advisor

Dr. Moges Ido

Abstract

Atrial fibrillation (AF) is a common cardiac arrhythmia, affecting 2.7-6.1 million people in the US. The lifetime risk of AF has been previously reported in whites, but not in African Americans. Lifetime risk of AF by socioeconomic status has not been investigated before. This study investigated the lifetime risk of AF in African Americans and in individuals with different socioeconomic status. The analysis included 15,343 whites and African Americans in the Atherosclerosis Risk in Communities (ARIC) study who were followed for an average of 21 years. For analysis, total family income was categorized as <$25,000, $25,000-$49,999, and ≥$50,000, and education as < high school graduate, high school graduate, and at least some college. Incident AF was ascertained from study electrocardiograms, hospital discharge records, and death certificates. Lifetime risk of AF was estimated by a modified Kaplan-Meier method. 2760 AF cases were identified during follow-up. Lifetime risk of AF was 36% (95% CI: 32-38%) in white men, 30% (26-32%) in white women, 21% (13-24%) in African American men, and 22% (16-25%) in African American women. Regardless of race and sex, incidence rates of AF decreased from the lowest to highest categories of income and education. In contrast, lifetime risk of AF increased in individuals with higher income and education in most sex-race groups. Cumulative incidence of AF was lower in those with higher income and education compared to their low socioeconomic status counterparts through earlier life but was reversed after age 85. The study concluded that lifetime risk of AF in the ARIC cohort was approximately 33% among whites and 20% among African Americans. Socioeconomic status was inversely associated with cumulative incidence of AF before the last decades of life.

Available for download on Thursday, April 18, 2019

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