Cardiovascular Disease Hospitalizations: Spotlighting Disparities by Race in Rheumatic Disease

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These data contribute to existing research into links observed between rheumatic diseases such as gout and cardiovascular disease among Indigenous North American populations.

Elizabeth Ferucci MD, MPH

Credit: UW Medicine

Elizabeth Ferucci MD, MPH

Credit: UW Medicine

There is an increased probability of cardiovascular disease hospitalizations among individuals with gout of all races, according to new findings, though a greater likelihood among those with rheumatic diseases other than gout or osteoarthritis is seen among Alaska Native/American Indian people.1

These findings were drawn from a recent study conducted to assess hospitalizations due to cardiovascular disease in the state of Alaska, looking at patients with and without a diagnosed rheumatic disease. The study also highlighted disparities in patients’ race, especially Indigenous populations known commonly as Alaska Native or American Indian.

This new research into rheumatic disease and hospitalization rates was led by Elizabeth D. Ferucci MD, MPH, from the research services department of the Alaska Native Tribal Health Consortium’s division of community health services. Ferucci and colleagues noted the prior dearth of race-stratified atherosclerotic cardiovascular disease data for those with conditions such as rheumatoid arthritis.2

“In the analysis presented herein, we focused on hospitalizations for cardiovascular disease in people with or without a rheumatic disease diagnosis during a hospitalization using the same dataset and similar methods to our previous publications,” Ferucci and colleagues wrote.

Background and Methods

The investigators drew data for their research from the Alaska Inpatient Database, a component of the state of Alaska’s Health Facilities Data Reporting Program (HFDR) on discharge information of Alaskan health facilities. The research team only implemented inpatient data as a consequence of the limited availability of outpatient data, de-identifying their dataset for the purposes of privacy.

Study subjects were given distinct identifiers, allowing the team to track over multiple admissions and allowing for the recording of demographic information such as gender, age, race, region, and hospital discharge diagnoses. The investigators’ criteria for inclusion among the subjects included being a resident of Alaska, aged 18 and older, having had a hospitalization between 2015 - 2018.

The research team compared a group of subjects with rheumatic disease to one without such diagnoses, having identified each group through the use of the International Classification of Diseases (ICD)-9 and ICD-10 over 9 disease categories. The team looked at cardiovascular disease hospitalizations through specific primary diagnosis codes, categorizing them into 5 specific groups: cerebrovascular disease, acute myocardial infarction, heart failure and cardiomyopathy, complications of hypertension, and coronary atherosclerosis and other heart diseases.

Findings

The investigators reported that among subjects without an identified rheumatic disease, 12.7% had been attributed to cardiovascular disease. This contrasted with 10.2% for subjects with osteoarthritis exclusively, 30.2% for subjects with gout, and 14.0% for subjects reporting other rheumatic conditions.

Those with a condition other than osteoarthritis were shown by the investigators to have exhibited greater odds of hospitalization due to cardiovascular disease, and the highest odds ratio was seen among subjects with gout versus alternative rheumatic conditions.

Notably, the investigators found that the presence of gout had raised the probability of cardiovascular disease hospitalization over all different racial categories, though among subjects with a rheumatic disease other than gout or osteoarthritis the odds were raised among Alaska Native/American Indian individuals specifically.

This notable racial disparity in hospitalizations was observed by the research team across all racial categories for gout compared to no rheumatic diseases, with the range being from 28.6% - 36.6% as opposed to 9.3% - 16.4%, respectively. Alternatively, it was seen solely among Alaska Native/American Indian individuals for other non-osteoarthritis rheumatic conditions in 14.1% compared to 9.3%, respectively.

“In the overall population, cardiovascular disease hospitalizations were less likely among AN/AI people in Alaska, but a rheumatic disease diagnosis increased the odds of cardiovascular disease hospitalization more among AN/AI people than those of White or other races,” they wrote. “This adds significantly to the literature on the association between rheumatic disease and cardiovascular disease in Indigenous North American populations.”

References

  1. Ferucci, E.D., Holck, P. An assessment of cardiovascular disease hospitalizations and disparities by race in patients with rheumatic disease hospitalizations in Alaska, 2015–2018. BMC Rheumatol 8, 7 (2024). https://doi.org/10.1186/s41927-024-00377-8.
  2. Daniel CM, Davila L, Makris UE, et al. Ethnic disparities in atherosclerotic Cardiovascular Disease incidence and prevalence among rheumatoid arthritis patients in the United States: a systematic review. ACR Open Rheumatol. 2020;2:525–32. https://doi.org/10.1002/acr2.11170. 2020/09/02.
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