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Table 2 Studies of antecedents and population-based occurrence of atrial fibrillation

From: Atrial fibrillation in the Indigenous populations of Australia, Canada, New Zealand, and the United States: a systematic scoping review

Author (Year) Publication type Country Indigenous population Calendar period Methods Key findings on Indigenous AF Quality score (Newcastle-Ottawa Scale applied only to Indigenous AF data) Comments
Antecedents of AF     
Title: Association of Markers of Inflammation with New-Onset Atrial Fibrillation in a Population-Based Sample: The Strong Heart Study
Zacks (2006) [32] Conference abstract Country: US Design: Population-based cohort study New-onset AF (n = 100 participants) independently predicted by serum CRP level (HR 1.44 per mg/L [95 % CI 1.17–1.77], p = 0.001), and by fibrinogen level (HR 1.31 per 83.44 mg/dL [=1 SD of mean][95 % CI 1.06–1.61], p = 0.013) NOS: N/A (abstract) No non-American Indian comparison group; data presented as generalisable evidence that CRP & fibrinogen are additive risk factors for new-onset AF (independent of effects of gender, age, hypertension, BMI, and urinary albumin-creatinine ratio)
Population: American Indians Data Source: Strong Heart   
Period: enrolled 1993–1995 with 10 years follow-up Study: prospectively collected population-based survey of risk factors   
Sample size: 3541 Setting: 13 American Indian communities   
  Sample size: 3541   
Title: Association of Left Ventricular Mass and Ejection Fraction with New-Onset Atrial Fibrillation in a Population-Based Sample: The Strong Heart Study
Zacks (2006) [33] Conference abstract Country: US Design: Population-based cohort study New-onset AF (n = 91 participants) independently predicted by increased LV mass indexed for height (HR 1.49 per 11 gm/m2.7 [=1 SD of mean][95 % CI 1.24–1.78], p ≤ 0.0001), and (n = 88) by reduced LVEF (HR 0.65 per 14 % [=1 SD of mean][95 % CI 0.52–0.82], p ≤ 0.0001) NOS: N/A (abstract) No non-American Indian comparison group; data presented as generalisable evidence that LV mass index and LVEF are additive risk factors for new-onset AF (independent of effects of gender, age, hypertension, BMI, urinary albumin-creatinine ratio, CRP and fibrinogen)
  Population: American Indians Data Source: Strong Heart   
  Period: enrolled 1993–1995 with 10 years follow-up Study: prospectively collected population-based survey of risk factors   
  Sample size: 3541 Setting: 13 American Indian communities   
   Sample size: 3541   
Incidence in population
Title: Cardiovascular Disease Rates, Outcomes, and Quality of Care in Ontario Métis: A Population-Based Cohort Study
Atzema (2015) [31] Journal article (this study has multiple outcomes) Country: Canada (Ontario only) Design: Retrospective cohort study (18 % of Métis population) Age- & sex-adjusted incidence per 100 (CI): Métis0.62 (0.50–0.73) NOS (cohort): 7/9 Incidence well-defined. Register not representative; Out-of-hospital cases not included; very small numbers of incident cases
  Population: Métis Data Source: Ontario Métis register linked to emergency department (ED), in-patient hospital & mortality records All Ontario 0.32 (0.32–0.32)  
  Period: 2006-2011 Setting: ED and hospital based cases p < 0.001  
  Age: 20 years & over Other: 5-year clearance period   
   Sample size: 56 cases of 12,550 (7 % of provincial Métis population)   
Title: Initial hospitalisation for atrial fibrillation in Aboriginal and non-Aboriginal populations in Western Australia
Katzenellenbogen (2015) [30] Conference abstract later published as a journal article (this study has multiple outcomes) Country: Australia (Western Australia only) Design: baseline data of retrospective cohort Aboriginal age-specific rates higher than non-Aboriginal rates in all ages <70 years NOS (adapted for cross-sectional): 10/10 Coverage of whole State with linked data but admitted hospital cases only; no data on diagnostic tests and medications; diagnostic codes not validated
  Population: Aboriginal Data Source: Linked hospital and death records ASRR: 20–54 years = 3.6 (males) and 6.4 (females) 55–84 years = 1.3 (males) and 1.8 (females)  
  Age: 20–84 years Setting: Western Australian hospital cases   
  Period: 2000-09 Other: 15-year clearance period   
   Sample size: 37,097 AF cases, 923 Aboriginal   
Prevalence in population
Title: Cardiovascular Disease Rates, Outcomes, and Quality of Care in Ontario Métis: A Population-Based Cohort Study
Atzema (2015) [31] Journal article (this study has multiple outcomes) Country: Canada (Ontario only) Design: Retrospective study Age- & sex-adjusted prevalence per 100 (CI): Métis 2.08 (1.82–2.34) NOS (adapted for cross-sectional): 8/10Prevalence not well-defined. Register not representative, out-of-hospital cases not included, numerators not provided and likely to be small numbers
  Population: Métis Data Source: Métis register linked to emergency department (ED), in-patient hospital & mortality records All Ontario 1.42 (1.41–1.43)  
  Period: 2006-2011 Setting: ED and hospital based cases p < 0.001  
  Age: 20 years & over Sample size: 12,550 (17 % of provincial Métis population)   
Title: Racial differences in the prevalence of atrial fibrillation among males
Borzecki (2008) [34] Journal article Country: US Design: Cross-sectional Prevalence in male Veterans higher among White than Native Americans Age-adjusted: White 5.7 % Native American 5.4 % Multivariate OR 1.15; 95 % CI 1.04-1.27 (adjusted for age, BMI and predisposing comorbidities) NOS: (adapted for cross-sectional) 10/10 High quality whole-of-nation study. Survey response only 67 % Whites & 55 % Native Americans, but analyses of administrative data from non-respondents support lower prevalence of AF among Native Americans vs Whites. Restricted to male veterans: military recruiting may limit generalisability
  Population: Native American/Alaskan/Hawaiian Data Source: administrative database plus health survey   
  Period: 1997-1999 Setting: population-based (male veterans)   
  Age: 18 years & over Sample size: 664,754 respondents (27,697 Native Americans)   
Titles: 1. Heart failure, ventricular dysfunction and risk factor prevalence in Australian Aboriginal peoples: the Heart of the Heart Study
2. Cardiometabolic risk and disease in Indigenous Australians: the Heart of the Heart Study
McGrady (2012) [36] Brown (2014) [35] Journal articles Country: Australia Design: Cross-sectional Crude prevalence of AF = 2.5 % Similar prevalence <40 and 40–55 years (1 %; n = 3), higher prevalence 56+ years (8 %; n = 8). Similar prevalence between remote and town communities. NOS (adapted for cross sectional): 8/10 (AF not main outcome) Standardised measurements; out-of-hospital and undiagnosed cases included; small numbers; estimated 10 % enrolled, representativeness unknown, possible selection bias
  Population: Aboriginal Data Source: Community survey, including psycho-social, biological and clinical measures   
  Age: 17+ years Setting: 3 communities in Central Australia   
  Period: 2008-09 Sample size: 436 volunteers   
Title: Twelve Lead Electrocardiographic Findings Among Māori and non-Māori at Risk of Cardiovascular Disease in NZ
Martin (2013) [37] Conference abstract Country: NZ Design: baseline descriptive (within cohort study) Atrial fibrillation frequencies: 2 % rural Māori 1.2 % urban Māori 0.4 % urban non-Māori NOS: N/A (abstract) No data provided on age/sex distribution, no statistical inference
  Population: Māori Data Source: ‘randomly selected’ community samples from the Hauora Manawa Community Heart Study cohort: 12-lead ECG   
  Age: 20–64 years Setting: two Māori Communities (rural, urban) and a non-Māori urban cohort   
  Period: Not known Sample size: 252 rural Māori, 243 urban Māori, 256 urban non- Māori   
Title: The Burden of Atrial Fibrillation in Octogenarians
Teh (2013) [38] Conference abstract Country: NZ Design: baseline descriptive (within cohort study) 30 % Māori versus 21 % non-Māori had AF, either on ECG or NZHIS records 7 % Māori versus 4 % non-Māori had AF newly detected by study ECG NOS: N/A (abstract) No statistical inferential data or eligibility exclusions reported Stroke reported as a comorbidity in 27 % of Māori and 35 % of non-Māori subjects
  Population: Māori Data Source: Life and Living to Advanced Age (NZ) cohort: 12-lead ECG plus NZHIS   
  Age: 80-90 Setting: community   
  Period: 2010-2011 Sample size: Overall cohort: 421 Māori aged 80–90; 516 non- Māori all aged 85.615 (66 %) participants had ECG; 870 (93 %) consented to NZHIS record examination   
Admission Rates (unlinked)
Title: The Management of People with Atrial Fibrillation and Flutter: Evidence-based Best Practice Guideline
New Zealand Guidelines Group (2005) [39] Report Country: NZ Design: Descriptive Hospital discharges with AF diagnosis: Age-standardised rate for Māori almost twice that of non-Māori (104 per 100,000 vs 57 per 100,000, p < 0.05) Standardised discharge ratio (observed versus expected) 1.945 for Māori & 0.972 for ‘others’ (where 1.0 is the national average) Modal age group: Māori 65–69 years, ‘other’ males 75–79 years, ‘other’ females >85 years NOS: N/A (report with insufficient methodological detail published) Unlinked administrative data
  Population: Māori Data Source: National minimum dataset   
  Period: 2001-2002 Setting: Hospital patients   
  Age: unrestricted Sample size: (whole of NZ data; sample size not stated)   
  1. AF atrial fibrillation, US United States, NOS Newcastle-Ottawa Scale, N/A not applicable, CRP C-reactive protein, HR hazard ratio, CI confidence interval, SD standard deviation, BMI Body-mass index, LV left ventricle, LVEF left ventricular ejection fraction, ED emergency department, ASRR age-standardised rate ratio, OR odds ratio, NZ New Zealand, ECG electrocardiograph, HZHIS New Zealand Health Information Service