Incidence of Heart Failure in Asian American, Native Hawaiian, and Other Pacific Islander Populations.

Abstract

Asian American, Native Hawaiian, and Other Pacific Islander (AANHPI) persons comprise ∼10% of the U.S. population-24 million people-yet a significant gap exists in contemporary data on incident heart failure (HF). The purpose of this study was to investigate the incidence of HF across disaggregated AANHPI individual groups. We identified adults aged ≥30 years without cardiovascular disease (CVD) within Kaiser Permanente Northern California and Kaiser Permanente Hawaii from 2012 to 2022. Incident HF through 2023 was defined as a hospitalization, ≥3 clinic visits, or death attributed to HF based on validated diagnostic codes from electronic health record and mortality data. We reported age-sex-adjusted incidence per 1,000 person-years with 95% CIs by AANHPI individual groups and calculated adjusted HRs for incident HF in each individual group compared with non-Hispanic White individuals. Among 2,652,271 adults without CVD, mean age was 49 ± 15 years and 53% were women. CVD risk factor prevalence was high, including hypertension (22%), dyslipidemia (26%), diabetes (7%), and overweight/obesity (56%). Distribution of self-reported racial/ethnic breakdown and rates of incident HF per 1,000 person-years were 6.8% Chinese (2.64; 95% CI: 2.55-2.73), 7.3% Filipino (5.07; 95% CI: 4.93-5.22), 2.4% Native Hawaiian/Other Pacific Islander (8.75; 95% CI: 8.31-9.21), 1.7% Japanese (3.07; 95% CI: 2.91-3.24), 0.8% Korean (2.44; 95% CI: 2.15-2.74), 3.5% South Asian (5.46; 95% CI: 5.1-5.84), 1.9% Vietnamese (3.05; 95% CI: 2.74-3.37), 1.0% other Southeast Asian (4.71; 95% CI: 4.1-5.36), and 74.5% non-Hispanic White (4.52; 95% CI: 4.49-4.56). Adjusting for age, sex, CVD risk factors, and neighborhood socioeconomic status, Chinese, Filipino, Japanese, Korean, Vietnamese, and other Southeast Asian adults had lower risk of incident HF, whereas Native Hawaiian/Other Pacific Islander and South Asian adults had higher risk compared with non-Hispanic White adults. Most AANHPI individual groups had lower adjusted risk of incident HF compared with non-Hispanic White adults, with Native Hawaiian/Other Pacific Islander and South Asian adults being notable exceptions. Our findings underscore the importance of disaggregating AANHPI populations to better understand risk profiles and mediators of incident HF.