PDF(Pubmed)
Abstract：
UNASSIGNED: The influence of race and ethnicity on initiation of direct oral anticoagulants (DOACs) is relatively understudied in Medicare data.
UNASSIGNED: To investigate disparities in the initiation of DOACs compared with warfarin by race, ethnicity, and social vulnerability.
UNASSIGNED: This retrospective cohort study used a 50% sample of Medicare fee-for-service data from January 1, 2010, to December 31, 2019 (mean patient enrollment duration, 7.7 years). Analysis took place between January 2023 and February 2024. A cohort of older adults (aged ≥65 years) with atrial fibrillation who newly initiated warfarin or DOACs (dabigatran, rivaroxaban, apixaban, and edoxaban) was identified.
UNASSIGNED: Patients were classified as non-Hispanic White, non-Hispanic Black, and Hispanic.
UNASSIGNED: The likelihood of starting use of DOACs compared with warfarin was modeled, adjusting for race, ethnicity, age, sex, county-level social vulnerability, and other clinical factors.
UNASSIGNED: Among 950 698 anticoagulation initiations, consisting of 680 974 DOAC users and 269 724 warfarin users (mean [SD] age, 78.5 [7.6] years; 52.6% female), 5.2% were Black, 4.3% were Hispanic, and 86.7% were White. During the 10-year study period, DOAC use increased for all demographic groups. After adjustment, compared with White patients, Black patients were 23% less likely (adjusted odds ratio [AOR, 0.77; 95% CI, 0.75-0.79) and Hispanic patients were 13% less likely (AOR, 0.87; 95% CI, 0.85-0.89) to initiate DOAC use. Disparities in DOAC initiation were greatest among Black patients in the earlier years but attenuated during the study period. For instance, in 2010, the OR of Black patients initiating DOACs was 0.54 (95% CI, 0.50-0.57), attenuating linearly over time to 0.69 by 2013 (95% CI, 0.65-0.74) and 0.83 (95% CI, 0.78-0.89) by 2017. By 2019, these differences became nonsignificant (OR, 1.08; 95% CI, 0.99-1.18).
UNASSIGNED: In this cohort study of Medicare patients with atrial fibrillation, Black and Hispanic patients were less likely to initiate DOACs for atrial fibrillation, although these differences diminished over time. Identifying the factors behind these early disparities is crucial for ensuring equitable access to novel therapies as they emerge for Black and Hispanic populations.
UNASSIGNED: To investigate disparities in the initiation of DOACs compared with warfarin by race, ethnicity, and social vulnerability.
UNASSIGNED: This retrospective cohort study used a 50% sample of Medicare fee-for-service data from January 1, 2010, to December 31, 2019 (mean patient enrollment duration, 7.7 years). Analysis took place between January 2023 and February 2024. A cohort of older adults (aged ≥65 years) with atrial fibrillation who newly initiated warfarin or DOACs (dabigatran, rivaroxaban, apixaban, and edoxaban) was identified.
UNASSIGNED: Patients were classified as non-Hispanic White, non-Hispanic Black, and Hispanic.
UNASSIGNED: The likelihood of starting use of DOACs compared with warfarin was modeled, adjusting for race, ethnicity, age, sex, county-level social vulnerability, and other clinical factors.
UNASSIGNED: Among 950 698 anticoagulation initiations, consisting of 680 974 DOAC users and 269 724 warfarin users (mean [SD] age, 78.5 [7.6] years; 52.6% female), 5.2% were Black, 4.3% were Hispanic, and 86.7% were White. During the 10-year study period, DOAC use increased for all demographic groups. After adjustment, compared with White patients, Black patients were 23% less likely (adjusted odds ratio [AOR, 0.77; 95% CI, 0.75-0.79) and Hispanic patients were 13% less likely (AOR, 0.87; 95% CI, 0.85-0.89) to initiate DOAC use. Disparities in DOAC initiation were greatest among Black patients in the earlier years but attenuated during the study period. For instance, in 2010, the OR of Black patients initiating DOACs was 0.54 (95% CI, 0.50-0.57), attenuating linearly over time to 0.69 by 2013 (95% CI, 0.65-0.74) and 0.83 (95% CI, 0.78-0.89) by 2017. By 2019, these differences became nonsignificant (OR, 1.08; 95% CI, 0.99-1.18).
UNASSIGNED: In this cohort study of Medicare patients with atrial fibrillation, Black and Hispanic patients were less likely to initiate DOACs for atrial fibrillation, although these differences diminished over time. Identifying the factors behind these early disparities is crucial for ensuring equitable access to novel therapies as they emerge for Black and Hispanic populations.
摘要：
■在医疗保险数据中，种族和民族对直接口服抗凝剂（DOAC）起始的影响研究相对不足。
■为了调查不同种族的DOAC与华法林的起始差异，种族,社会脆弱性。
■这项回顾性队列研究使用了从2010年1月1日至2019年12月31日的50％的Medicare按服务收费数据样本（平均患者入组时间，7.7年）。分析发生在2023年1月至2024年2月之间。新开始使用华法林或DOAC（达比加群，利伐沙班,阿哌沙班,和edoxaban)被识别。
■患者被归类为非西班牙裔白人，非西班牙裔黑人,和西班牙裔。
■对开始使用DOAC与华法林相比的可能性进行了建模，适应种族，种族,年龄,性别,县级社会脆弱性，和其他临床因素。
■在950698次抗凝治疗中，由680974名DOAC用户和269724名华法林用户组成(平均[SD]年龄，78.5[7.6]岁；52.6%为女性)，5.2%为黑色，4.3%是西班牙裔，白人占86.7%。在为期10年的研究期间，DOAC的使用增加了所有人口群体。调整后,与白人患者相比，黑人患者的可能性降低了23%(调整后的比值比[AOR，0.77;95%CI，0.75-0.79)和西班牙裔患者的可能性较低13%(AOR，0.87；95%CI，0.85-0.89）开始使用DOAC。早期黑人患者的DOAC起始差异最大，但在研究期间有所减弱。例如,2010年，Black患者开始DOAC的OR为0.54(95%CI，0.50-0.57)，到2013年线性衰减到0.69（95%CI，0.65-0.74），到2017年线性衰减到0.83（95%CI，0.78-0.89）。到2019年，这些差异变得不显著(或，1.08；95%CI，0.99-1.18）。
■在这项针对Medicare房颤患者的队列研究中，黑人和西班牙裔患者不太可能启动DOAC治疗心房颤动，尽管这些差异随着时间的推移而减少。确定这些早期差异背后的因素对于确保黑人和西班牙裔人群公平获得新疗法至关重要。
■为了调查不同种族的DOAC与华法林的起始差异，种族,社会脆弱性。
■这项回顾性队列研究使用了从2010年1月1日至2019年12月31日的50％的Medicare按服务收费数据样本（平均患者入组时间，7.7年）。分析发生在2023年1月至2024年2月之间。新开始使用华法林或DOAC（达比加群，利伐沙班,阿哌沙班,和edoxaban)被识别。
■患者被归类为非西班牙裔白人，非西班牙裔黑人,和西班牙裔。
■对开始使用DOAC与华法林相比的可能性进行了建模，适应种族，种族,年龄,性别,县级社会脆弱性，和其他临床因素。
■在950698次抗凝治疗中，由680974名DOAC用户和269724名华法林用户组成(平均[SD]年龄，78.5[7.6]岁；52.6%为女性)，5.2%为黑色，4.3%是西班牙裔，白人占86.7%。在为期10年的研究期间，DOAC的使用增加了所有人口群体。调整后,与白人患者相比，黑人患者的可能性降低了23%(调整后的比值比[AOR，0.77;95%CI，0.75-0.79)和西班牙裔患者的可能性较低13%(AOR，0.87；95%CI，0.85-0.89）开始使用DOAC。早期黑人患者的DOAC起始差异最大，但在研究期间有所减弱。例如,2010年，Black患者开始DOAC的OR为0.54(95%CI，0.50-0.57)，到2013年线性衰减到0.69（95%CI，0.65-0.74），到2017年线性衰减到0.83（95%CI，0.78-0.89）。到2019年，这些差异变得不显著(或，1.08；95%CI，0.99-1.18）。
■在这项针对Medicare房颤患者的队列研究中，黑人和西班牙裔患者不太可能启动DOAC治疗心房颤动，尽管这些差异随着时间的推移而减少。确定这些早期差异背后的因素对于确保黑人和西班牙裔人群公平获得新疗法至关重要。
