The Sensitivity of the Method Used to Detect Atrial Fibrillation in Population Studies Affects Group-Specific Prevalence Estimates : Ethnic and Regional Distribution of Atrial Fibrillation in the REGARDS Study

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概要

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• Background: Among African-Americans, and in southern US states, the rates of stroke are high but the reported prevalences of atrial fibrillation (AF) are low. We hypothesized that the reported ethnic and regional distributions of AF are affected by the sensitivity of the methods that were used to detect AF in previous reports.Methods: A total of 18 833 black and white participants from the US national REasons For Geographic And Racial Differences In Stroke (REGARDS) study were included in this analysis. Levels of sensitivity to detect AF, from least to most sensitive, were created for combinations of self-report (SR) and ECG methods, as follows: (1) SR plus ECG, (2) ECG alone, (3) SR alone, and (4) SR or ECG. Geographic regions were dichotomized as Stroke Belt (the southern US states) and non-Stroke Belt. Logistic regression analysis estimated the odd ratios of AF associated with the Stroke Belt and black ethnicity for each diagnostic combination.Results: Residence in the Stroke Belt was significantly associated with AF when diagnosed by SR plus ECG (multivariable-adjusted OR, 0.66; 95% CI, 0.47 to 0.92), but not when diagnosed with SR or ECG (OR, 0.95; 95% CI, 0.85 to 1.06). Similarly, for the 4 methods used to detect AF, the strength of the association between black ethnicity and AF progressively decreased with increasing test sensitivity (ORs: 0.20, 0.40, 0.70, 0.71, respectively).Conclusions: The association of AF with residence in the Stroke Belt and black ethnicity was inversely related to the sensitivity of the method used to detect AF: as test sensitivity increased, the association became attenuated. This may partially explain the lower reported prevalence of AF in populations and regions with higher stroke rates.

• 日本疫学会の論文
• 2009-07-01

著者

• Cushman Mary

  Department Of Medicine University Of Vermont College Of Medicine

• Zhang Zhu-ming

  Department Of Epidemiology And Prevention Wake Forest University School Of Medicine

• Soliman Elsayed

  Department Of Epidemiology And Prevention Wake Forest University School Of Medicine

• PRINEAS Ronald

  Department of Epidemiology and Prevention, Wake Forest University School of Medicine

• HOWARD George

  Departments of Biostatistics, School of Public Health, University of Alabama

• HOWARD Virginia

  Departments of Epidemiology, School of Public Health, University of Alabama

• MOY Claudia

  National Institute of Neurological Disorders and Stroke, National Institutes of Health

• Howard George

  Department Of Biostatistics University Of Alabama At Birmingham School Of Public Health

• Moy Claudia

  National Institute Of Neurological Disorders And Stroke National Institutes Of Health

• Prineas Ronald

  Department Of Epidemiology And Prevention Wake Forest University School Of Medicine

• Howard Virginia

  Departments Of Epidemiology School Of Public Health University Of Alabama

• Howard Virginia

  Department Of Epidemiology University Of Alabama At Birmingham

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