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Ethnicity and socioeconomic deprivation are independent predictors of major bleeds among patients without CVD, but it is unclear whether they are also predictors of major bleeds among patients with CVD or atrial fibrillation (AF) after adjustment for clinical variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Prospective cohort study of 488,107 people in New Zealand Primary Care (including 64,420 M\u0101ori, the indigenous people of New Zealand) aged 30\u201379\u00a0years who had their CVD risk assessed between 2007 and 2016. Participants were divided into three mutually exclusive subgroups: (1) AF with or without CVD (n\u2009=\u200915,212), (2) CVD and no AF (n\u2009=\u200943,790), (3) no CVD or AF (n\u2009=\u2009429,105). Adjusted hazards ratios (adjHRs) were estimated from Cox proportional hazards models predicting major bleeding risk for each of the three subgroups to determine whether ethnicity and socioeconomic deprivation are independent predictors of major bleeds in different cardiovascular risk groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In all three subgroups (AF, CVD, no CVD\/AF), M\u0101ori (adjHR 1.63 [1.39\u20131.91], 1.24 [1.09\u20131.42], 1.57 [95% CI 1.45\u20131.70], respectively), Pacific people (adjHR 1.90 [1.58\u20132.28], 1.30 [1.12\u20131.51], 1.62 [95% CI 1.49\u20131.75], respectively) and Chinese people (adjHR 1.53 [1.08\u20132.16], 1.15 [0.90\u20131.47], 1.13 [95% CI 1.01\u20131.26], respectively) were at increased risk of a major bleed compared to Europeans, although for Chinese people the effect did not reach statistical significance in the CVD subgroup. Compared to Europeans, M\u0101ori and Pacific peoples were generally at increased risk of all bleed types (gastrointestinal, intracranial and other bleeds). An increased risk of intracranial bleeds was observed among Chinese and Other Asian people and, in the CVD and no CVD\/AF subgroups, among Indian people. Increasing socioeconomic deprivation was also associated with increased risk of a major bleed in all three subgroups (adjHR 1.07 [1.02\u20131.12], 1.07 [1.03\u20131.10], 1.10 [95% CI\u00a01.08\u20131.12], respectively, for each increase in socioeconomic deprivation quintile).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Ethnicity and socioeconomic status should be considered in bleeding risk assessments to guide the use of antithrombotic medication for the management of AF and CVD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12872-021-01993-9","type":"journal-article","created":{"date-parts":[[2021,4,23]],"date-time":"2021-04-23T06:04:14Z","timestamp":1619157854000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Risk of major bleeding by ethnicity and socioeconomic deprivation among 488,107 people in primary care: a cohort study"],"prefix":"10.1186","volume":"21","author":[{"given":"Wai Chung","family":"Tse","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Corina","family":"Grey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matire","family":"Harwood","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rod","family":"Jackson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Kerr","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suneela","family":"Mehta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katrina","family":"Poppe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Romana","family":"Pylypchuk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sue","family":"Wells","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9824-8674","authenticated-orcid":false,"given":"Vanessa","family":"Selak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,4,23]]},"reference":[{"key":"1993_CR1","doi-asserted-by":"publisher","DOI":"10.7326\/M18-2808","author":"V Selak","year":"2019","unstructured":"Selak V, Jackson R, Poppe K, Wu B, Harwood M, Grey C, et al. 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Euro Heart Survey Chest. 2010;138:1093\u2013100.","journal-title":"Euro Heart Survey Chest"}],"container-title":["BMC Cardiovascular Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12872-021-01993-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12872-021-01993-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12872-021-01993-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,23]],"date-time":"2021-04-23T06:11:14Z","timestamp":1619158274000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmccardiovascdisord.biomedcentral.com\/articles\/10.1186\/s12872-021-01993-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,23]]},"references-count":52,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1993"],"URL":"https:\/\/doi.org\/10.1186\/s12872-021-01993-9","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-98289\/v1","asserted-by":"object"},{"id-type":"doi","id":"10.21203\/rs.3.rs-144018\/v1","asserted-by":"object"}]},"ISSN":["1471-2261"],"issn-type":[{"value":"1471-2261","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,23]]},"assertion":[{"value":"15 December 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 April 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 April 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The PREDICT study (under which this research was conducted) was approved by the New Zealand Northern Region Ethics Committee Y in 2003 (AKY\/03\/12\/314), with subsequent annual approval by the New Zealand National Multi Region Ethics Committee since 2007 (MEC07\/19\/EXP). Participant informed consent was not obtained, consistent with a waiver granted by the ethics committee, because the study involved secondary use of patient data that was anonymized prior to being received by the research team.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"This research was funded by a Project Grant (15\/165) from the Health Research Council of New Zealand (HRC). CG, MH, RJ, AK, SM, KP and SW are receiving funding from the HRC for programme, project and Clinical Research Training grants for CVD research. KP is the recipient of a Heart Foundation of New Zealand Hynds Senior Fellowship and CG was the recipient of a National Heart Foundation of New Zealand Research Fellowship. SW was the recipient of a Fellowship in Health Innovation and Quality Improvement, funded by the Stevenson Foundation. Outside of this research, SW and KP have received funding from the Heart Foundation of New Zealand (Project Grant for quality improvement and structural heart disease, respectively) and SW from Roche Diagnostics Ltd (Project Grant for point of care testing trial).","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interests"}}],"article-number":"206"}}