3.2 Incident heart failure hospitalizations by ethnicity 123 of the patients were men and they were predominantly Malay (60.9%). Patients of Chinese ethnicity had markedly older age of onset for first HF hospitalizations than all the other ethnic groups. Crude incidence rates were reported in Table 2. The annual crude incidence rate for HF hospitalization in women was lower than in men (52.8 per 100 000 vs 65.5 per 100 000 population in 2016). This translates into a 23% lower incidence rate in women compared to men, after adjusting for age and calendar year (incidence rate ratio (IRR) 0.77; 95%CI (confidence interval), 0.74-0.80) (Supplementary table 1). Incidence of HF hospitalizations varied widely between ethnicities, where it was highest in Indians, followed by Malays, the other ethnicities group and Chinese (standardised incidence rates were 86.7, 78.9, 60.9 and 32.3 per 100 000 in 2016) (Supplementary table 2). After adjusting for age, sex and calendar year, persons of Indian ethnicity had 20% higher incidence compared to Malays, the largest ethnic group in Malaysia (IRR 1.20, 95% CI 1.14 – 1.26, p-value<0.001) (Supplementary table 3) By age, incidence rate peaked at the 80 to <85 years category while the lowest incidence rate was in the youngest age category (20 to <25 years). Trends on incident HF hospitalization The overall rate of incident HF hospitalization declined by 1% annually after accounting for age and sex (IRR per calendar year 0.99 (95% CI, 0.982-0.996), p-value = 0.003). The rate of decline in incidence rates were proportional for men and women (Figure1) and the corresponding age-adjusted interaction term between calendar year and sex also showed no difference (p-value= 0.347). Upon stratification by age, the trend lines for incidence in men and women overlapped at the youngest ages but began to separate from the 40 to <45 years category, where men showed a slightly quicker rise in incidence (Figure 2). Then, the incidence rates stabilised for ages 50 to <60 for both sex groups followed by declines from age 60 years onwards. This reduction in women appeared to level off from the age category of 75 to <80 onwards whilst incidence rates for men continued to decline. Next, Figure 3 contrasted the ten-year difference in incidence by age group and sex. In men, a slight increase in incidence was seen between age 30 to 65 years. This was in contrast to the drop observed from age 65 years onwards, with the most apparent lowering of incidence in the peak ages, i.e., the 80 to <85-year age group (a difference in incidence = 467.2- 553.6= -86.4 per 100 000). Although a similar
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