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Age and gender disparities in oral anticoagulant use: a nine-year nationwide drug utilization analysis
Ahmed A A Omer1,2, Márta Csatordai1,3, Réka Viola1,3
1Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary.
Insights
Oral anticoagulant (OAC) use in Hungary nearly doubled from 2014-2022, with a significant shift from vitamin K antagonists (VKAs) to direct oral anticoagulants (DOACs). A widening gender gap in OAC consumption was observed, with higher usage in males.
Area of Science:
- Pharmacology
- Public Health
- Epidemiology
Background:
- Cardiovascular diseases (CVDs) are the leading cause of mortality in Europe, with Hungary experiencing rates double the EU average.
- Oral anticoagulants (OACs) are vital for reducing CVD mortality.
- The use of OACs has shifted from vitamin K antagonists (VKAs) to direct oral anticoagulants (DOACs) over the past decade.
Purpose of the Study:
- To analyze population-level trends in OAC consumption in Hungary between 2014 and 2022.
- To examine OAC usage patterns stratified by age and gender.
- To identify temporal changes in the gender gap of OAC consumption.
Main Methods:
- Utilized national-level prescription data from the Hungarian National Health Insurance Fund.
- Measured OAC utilization using the WHO's ATC/DDD methodology (defined daily doses per 1,000 inhabitants per day - DID).
- Assessed trends using linear regression analysis.
Main Results:
- Total OAC consumption nearly doubled (9.79 to 18.73 DID), driven by a tenfold increase in DOACs use as VKAs use declined.
- OAC utilization was consistently higher in males and increased with age, peaking in the 80-84 age group.
- A widening gender gap in DOAC consumption emerged from 2018, while VKAs showed a consistent gender disparity.
Conclusions:
- Hungary witnessed a significant transition from VKAs to DOACs, nearly doubling overall OAC use.
- A widening gender gap in OAC consumption was observed for both VKAs and DOACs.
- Consistent higher utilization in males and increasing use with age underscore the need for monitoring anticoagulant therapy.
Background:
Cardiovascular diseases remain the leading cause of mortality in Europe, responsible for one-third of all deaths in 2021. In Hungary, the standardized death rate from cardiovascular diseases reached 722.8 per 100,000 individuals, more than double the EU average. Oral anticoagulants (OACs) play a crucial role in lowering cardiovascular mortality. The use of OACs has shifted rapidly over the past decade with the transition from vitamin K antagonists (VKAs) to direct oral anticoagulants (DOACs). Although previous studies have examined gender differences in OACs prescribing, most rely on patient-level registries and do not capture population-level exposure.
Aim:
To evaluate population-level trends in OACs consumption in Hungary from 2014 to 2022, stratified by age and gender, with a specific focus on detecting temporal changes in the gender gap.
Method:
National level data were obtained from the Hungarian National Health Insurance Fund database, which includes all reimbursed prescription medications for the entire population. Utilization was measured using the WHO's ATC/DDD methodology and expressed as defined daily doses per 1,000 inhabitants per day (DID). Linear regression was used to assess trends.
Results:
Total OACs use nearly doubled over the study period, increasing from 9.79 to 18.73 DID (Coeff. = 1.18, p < 0.001). VKAs use declined significantly in both genders by 41.2% in males and 47.8% in females, while DOACs use increased more than tenfold. OACs utilization was consistently higher in males. Gender differences in DOACs, initially negligible, began to widen from 2018 onward, whereas, VKAs utilization exhibited a consistently wider gender difference across all years. OACs use increased with age, peaking in the 80-84 age group. Apixaban became the most used OAC, reaching 6.11 DID in 2022.
Conclusion:
A marked shift from VKAs to DOACs occurred, with overall OACs use nearly doubling, with a widening gender gap in consumption of both VKAs and DOACs. Utilization was consistently higher among males and increased with age, highlighting the importance of continued monitoring to ensure effective and evidence-based anticoagulant use.
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