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

Abstract

Background: 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).

Objectives: The purpose of this study was to investigate the incidence of HF across disaggregated AANHPI individual groups.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Asian American; Native Hawaiian; Pacific Islander; heart failure; outcomes.