Oral anticoagulation (OAC) is the gold standard for stroke prevention in people with atrial fibrillation (AF). The social determinants of health have received little attention in AF, particularly regarding OAC. The influence of the area deprivation index (ADI) on OAC prescription and agent selection was investigated (warfarin or direct-acting OAC). For a study, researchers performed a retrospective examination of patients with the incident, non-valvular AF, who received care at a large, regional health institution between 2015 and 2020. First, they extracted demographics, prescriptions, and issue lists and then used administrative coding to identify comorbid conditions and pertinent variables and the Zip+4 to calculate ADI. Finally, they investigated the relationship between ADI and OAC prescription and selection 90 days after the AF diagnosis in multivariable-adjusted models.
Following exclusions, the dataset contained 20,210 people (age 74.5±10.9 years; 51% (10,270 of 20,210) were women; and 94% (19,053 of 20,210) were white. Individuals in the highest ADI quartile were 13% less likely to obtain OAC than those in the lowest quartile (adjusted Odds Ratio [OR] 0.87; 95% CI, 0.77-0.98) 90 days after AF diagnosis. Individuals in the highest quartile of ADI were 21% less likely than those in the lowest quartile to receive a more contemporary direct-acting OAC than warfarin at 90 days after AF diagnosis (aOR 0.79; 95% CI, 0.63-0.99). They showed that ADI was linked to access to OAC for stroke prevention in AF and the likelihood of being treated with a more modern direct-acting OAC (rather than warfarin). In a broad, regional health care system, the findings revealed health disparities in the provision of anticoagulation for stroke prevention in AF.
Reference:www.ahajournals.org/doi/10.1161/circ.145.suppl_1.070
