Advocate Aurora Research Institute, Advocate Aurora Health, Downers Grove, IL.
School of Molecular & Cellular Biology, University of Illinois at Urbana-Champaign, Urbana, IL.
Medicine (Baltimore). 2022 Sep 2;101(35):e29997. doi: 10.1097/MD.0000000000029997.
A growing body of literature now exists examining associations between social determinants of health (SDOH) and adverse outcomes in patients with atrial fibrillation; however, little is available on anticoagulant prescriptions and the impact of SDOH.
Evaluate the impact of SDOH on anticoagulant prescriptions in patients with atrial fibrillation.
Medline and Embase databases up to January 2021.
Noninterventional studies were included if they reported associations between at least 1 of 14 SDOH domains and anticoagulant prescription in patients with atrial fibrillation. Two investigators independently screened and collected data.
Two investigators independently screened and collected data.
Meta-analyses using random-effect models evaluated associations between SDOH and receiving an anticoagulant prescription. We included 13 studies, 11 of which were included in meta-analyses that reported on the impact of 9 of the 14 SDOH included in the search. Pooled estimates indicate a 0.85 (95% confidence interval [CI]: 0.75, 0.97) lower odds of receiving anticoagulant prescriptions among Black compared to non-Black patients (reported in 6 studies); 0.42 (95% CI: 0.32, 0.55) lower odds of receiving anticoagulant prescriptions among patients with mental illness compared to those without mental illness (2 studies); and a 0.64 (95% CI: 0.42, 0.96) lower likelihood of receiving oral anticoagulant prescription among employed patients compared to unemployed patients (2 studies).
SDOH lack consistent definitions and measures within the electronic health record.
The literature reports on only half of the SDOH domains we searched for, indicating that many SDOH are not routinely assessed. Second, social needs impact the decision to prescribe anticoagulants, confirming the need to screen for and address social needs in the clinical setting to support clinicians in providing guideline concordant care to their patients.
This systematic review and meta-analysis was registered with PROSPERO.
现在有越来越多的文献研究社会决定因素（SDOH）与心房颤动患者不良结局之间的关系；然而，关于抗凝药物处方和 SDOH 的影响的信息却很少。
评估 SDOH 对心房颤动患者抗凝药物处方的影响。
截至 2021 年 1 月，使用 Medline 和 Embase 数据库。
如果报告了至少 14 个 SDOH 领域中的 1 个与心房颤动患者的抗凝药物处方之间的关系，则纳入非干预性研究。两名调查员独立筛选和收集数据。
两名调查员独立筛选和收集数据。
使用随机效应模型进行荟萃分析，评估 SDOH 与接受抗凝药物处方之间的关系。我们纳入了 13 项研究，其中 11 项研究纳入了荟萃分析，报告了搜索中包含的 14 个 SDOH 中的 9 个对接受抗凝药物处方的影响。汇总估计表明，与非黑人患者相比，黑人患者接受抗凝药物处方的可能性低 0.85（95%置信区间[CI]：0.75，0.97）（6 项研究报告）；与无精神疾病的患者相比，有精神疾病的患者接受抗凝药物处方的可能性低 0.42（95% CI：0.32，0.55）（2 项研究报告）；与失业患者相比，就业患者接受口服抗凝药物处方的可能性低 0.64（95% CI：0.42，0.96）（2 项研究报告）。
SDOH 在电子健康记录中缺乏一致的定义和衡量标准。
文献仅报告了我们搜索的 SDOH 领域的一半，这表明许多 SDOH 并未常规评估。其次，社会需求影响抗凝药物处方的决定，这证实了需要在临床环境中筛查和解决社会需求，以支持临床医生为患者提供符合指南的护理。
本系统评价和荟萃分析已在 PROSPERO 注册。
