Racial differences in bleeding risk: An ecological epidemiological study comparing Korea and United Kingdom subjects

Background: This study aimed to evaluate racial differences in bleeding incidence by conducting an ecological epidemiological study using data from Korea and the UK. Methods: We included healthy participants from the Korean National Health Insurance Service-Health Screening and the UK Biobank who underwent health examinations between 2006 and 2010 and had no comorbidities or history of medication use. Finally, 112,750 East Asians (50.7% men, mean age 52.6 years) and 210,995 Caucasians (44.7% men, mean age 55.0 years) were analyzed. The primary outcome was composed of intracranial hemorrhage (ICH) and bleeding from the gastrointestinal, respiratory, and genitourinary systems. Results: During the follow-up, primary outcome events occurred in 2110 East Asians and in 6515 Caucasians. East Asians had a 38% lower five-year incidence rate compared to Caucasians (3.88 vs. 6.29 per 1000 person-years; incidence rate ratio [IRR] 0.62, 95% confidence interval [CI] 0.59.0.65). East Asians showed a lower incidence of major bleeding (IRR 0.86, 95% CI 0.81.0.91), bleeding from the gastrointestinal (IRR 0.53, 95% CI 0.49. 0.56), and genitourinary systems (IRR 0.49, 95% CI 0.44.0.53) compared to Caucasians. The incidence rates of ICH (IRR 3.20, 95% CI 2.67.3.84) and bleeding from the respiratory system (IRR 1.28, 95% CI 1.11.1.47) were higher in East Asians. Notably, East Asians consuming alcohol .3 times/week showed a higher incidence of the primary outcome than Caucasians (IRR 1.12, 95% CI 1.01.1.25). Conclusions: This ecological study revealed significant racial differences in bleeding incidence, influenced by anatomical sites and lifestyle habits, underscoring the need for tailored approaches in bleeding management based on race.