Abstract
Background
It remains unclear whether racial and ethnic disparities for atherosclerotic cardiovascular
disease (ASCVD) persist within universal health care systems. We aimed to explore
long-term ASCVD outcomes within a single-payer health care system with extensive drug
coverage in Québec, Canada.
Methods
CARTaGENE (CaG) is a population-based prospective cohort study of individuals aged
40 to 69 years. We included only participants without previous ASCVD. The primary
composite endpoint was time to the first ASCVD event (cardiovascular death, acute
coronary syndrome, ischemic stroke-transient ischemic attack, or peripheral arterial
vascular event).
Results
The study cohort included 18,880 participants followed for a median of 6.6 years (2009
to 2016). The mean age was 52 years, and 52.4% were female. After further adjustment
for socioeconomic and cardiovascular factors, the increase in ASCVD risk for South
Asians (SAs) was attenuated (hazard ratio [HR], 1.41; 95% confidence interval [CI],
0.75, 2.67), whereas Black participants’ risk was lower (HR, 0.52; 95% CI, 0.29, 0.95)
compared with White participants. After similar adjustments, there were no significant
differences in ASCVD outcomes among the Middle Eastern, Hispanic, East-Southeast Asian,
Indigenous, and mixed race-ethnicities participants and the White participants.
Conclusions
After adjustment for CV risk factors, the risk of ASCVD was attenuated in the SA CaG
participants. Intensive risk-factor modification may mitigate the ASCVD risk of the
SAs. Within a universal health care context and comprehensive drug coverage, the ASCVD
risk was lower among Black compared with White CaG participants. Future studies are
needed to confirm whether universal and liberal access to health care and medications
can reduce the rates of ASCVD among the Black population.
Résumé
Contexte
Des doutes subsistent quant à la persistance des disparités raciales et ethniques
en matière de maladies cardiovasculaires athéroscléreuses (MCVA) dans les systèmes
de soins de santé universels. Nous avons voulu étudier les issues à long terme des
MCVA au sein d’un système de soins de santé à payeur unique avec une couverture étendue
des médicaments, en l’occurrence au Québec (Canada).
Méthodologie
CARTaGENE (CaG) est étude de cohorte prospective menée auprès d’une population d’individus
âgés de 40 à 69 ans. Seuls les participants sans MCVA antérieure ont été inclus. Le
critère composé principal était le temps écoulé avant le premier événement de MCVA
(décès d’origine cardiovasculaire, syndrome coronarien aigu, accident vasculaire cérébral
ischémique, accident ischémique transitoire ou maladie artérielle périphérique).
Résultats
La cohorte comprenait 18 880 participants suivis pendant une durée médiane de 6,6
ans (de 2009 à 2016). L’âge moyen était de 52 ans, et 52,4 % des sujets étaient des
femmes. Après un ajustement supplémentaire pour tenir compte des facteurs socio-économiques
et cardiovasculaires, la hausse du risque de MCVA chez les Sud-Asiatiques a été atténuée
(rapport des risques instantanés [RRI] : 1,41; intervalle de confiance [IC] à 95 %
: 0,75-2,67), tandis que le risque était plus faible pour les participants noirs (RRI
: 0.52 ; IC à 95 % : 0,29-0,95) que pour les participants blancs. Après des ajustements
similaires, aucune différence significative n’a été observée quant aux cas de MCVA
entre les participants du Moyen-Orient, les Hispaniques, les Asiatiques de l’Est et
du Sud-Est, les Autochtones et les participants de race mixte ou les participants
blancs.
Conclusions
Après un ajustement pour tenir compte de facteurs de risque cardiovasculaire, le risque
de MCVA était atténué chez les Sud-Asiatiques de l’étude CaG. Une modification intensive
des facteurs de risque peut expliquer la baisse observée dans cette population. Dans
le contexte d’un système de soins de santé universel offrant une couverture complète
des médicaments, le risque de MCVA était par ailleurs plus faible chez les participants
noirs que chez les participants blancs de l’étude CaG. D’autres études sont toutefois
requises pour vérifier si un accès libre et universel aux soins de santé et aux médicaments
peut expliquer la réduction des taux de MCVA au sein de la population noire.
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Article info
Publication history
Published online: March 11, 2023
Accepted:
March 7,
2023
Received:
October 23,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
See editorial by Deb et al., pages xxx-xxx of this issue.
See page 8 for disclosure information.
Identification
Copyright
© 2023 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
ScienceDirect
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- If You Can’t Measure It, You Can’t Improve It: Data Collection and Standards in the Evaluation of Racial and Ethnic Disparities in Cardiovascular DiseaseCanadian Journal of Cardiology
- PreviewIn Canada, 1 in 4 people is a member of a race and ethnic minority group.1 Comprising of approximately 20% of the Canadian population are South Asian (2.6 million, 7.1%), Chinese (1.7 million, 4.7%), Black (1.5 million, 4.3%), and Filipino (960,000, 2.6%) people.1 Despite the availability of universal health care in Canada that is funded publicly, it has been widely studied that universality by itself is insufficient to mitigate racial and ethnic disparities. As the diversity in the Canadian population continues to grow, optimal delivery of care is predicated on a nuanced and comprehensive understanding of our patients from a biopsychosocial perspective.
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