3.2 Incident heart failure hospitalizations by ethnicity 121 and records which contained illogical characters or length in the identifier were excluded. From 2007 to 2016, 157 493 hospitalizations had a primary diagnosis of HF (Supplementary Figure 1). Of these, 1713 hospitalizations had either no unique identifier, incorrect format for the identifier or were duplicate entries. To isolate only incident HF hospitalizations, 50 381 repeat admissions were excluded, leaving 105 399 cases for inclusion in the analysis. Definitions HF hospitalization was defined based on a discharge diagnosis of ICD-10 codes of HF which is I50.[10–12] The classification of ethnicity was defined based on the Public Sector Data Dictionary (PSDD) for the Health Informatics Standards (Second edition, Dec 2007) in Malaysia.[13] Ethnicity was recorded as stated by patients or their caregivers based on the categories in the PSDD.[13] They were then categorised into four groups as follows: (i) Malay, (ii) Chinese, (iii) Indian and (iv) other ethnicities which included Peninsular Malaysia, Sabah or Sarawak indigenous groups, Bajau, Kadazan, Murut, Melanau, Kedayan, Iban, Bidayuh, Bumiputera Sabah or Sarawak, other ethnic groups and foreign nationalities. Ethical considerations Ethics approval was granted by the Medical Research and Ethics Committee, MOH Malaysia (NMRR-19-1108-47994) with permission to use unique identifiers to perform data linkages. Waiver of patient consent was approved because this study was conducted using observational data collected from routine clinical care and all data linkages were performed within the data environment of the Health Informatics Centre. Only aggregated data without identifying information were exported for analysis. Statistical Analysis Descriptive statistics on patient demographic characteristics were presented. As missing rates for the unique personal identification number were about 1%, we excluded those observations with missing identification number. For descriptive analysis, continuous data were reported as means with standard deviation (SD) or
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