Racial/Ethnic Disparities in Anticoagulation for Atrial Fibrillation by Sex and Within High and Low Stroke Risk...

Area of Science:

• Cardiology
• Health Disparities
• Pharmacology

Background:

• Atrial fibrillation (AF) significantly increases the risk of thromboembolic stroke.
• Oral anticoagulants (OACs) are crucial for reducing stroke risk in AF patients.
• Prior research indicates OAC underprescription in female, Black, Hispanic, and Asian populations.

Purpose of the Study:

• To investigate OAC prescription rates across different racial/ethnic groups in AF patients.
• To analyze OAC disparities based on sex and CHA2DS2-VASc risk stratification.
• To identify specific subgroups experiencing the most significant OAC underuse.

Main Methods:

• Utilized a database of patients diagnosed with atrial fibrillation.
• Employed logistic regression models to assess associations between race/ethnicity and OAC rates.
• Subgroup analyses were conducted by sex and CHA2DS2-VASc risk categories (low and high).

Main Results:

• Black, Hispanic, and Asian individuals with AF showed lower OAC rates than white individuals.
• Female patients with AF had significantly lower OAC rates compared to male patients.
• Disparities were more pronounced in men across all non-white groups; in women, only Black women showed lower rates. Low-risk Asian and high-risk Black individuals had reduced OAC use.

Conclusions:

• Significant racial/ethnic and sex-based disparities exist in OAC prescribing for AF patients.
• Black women experience a compounded disadvantage ('double hit') in OAC utilization.
• Targeted, equity-focused interventions are needed to address these OAC prescribing gaps, particularly for Black women.