Jackson Larry R, Kang Amiee, Noxon Virginia, Atreja Nipun, Hines Dionne M, Hagan Melissa, Jiang Jenny, Atwater Brett D
Duke Clinical Research Institute, Durham, NC, United States of America.
Bristol Myers Squibb, Lawrenceville, NJ, United States of America.
PLoS One. 2024 Dec 12;19(12):e0314345. doi: 10.1371/journal.pone.0314345. eCollection 2024.
Use of oral anticoagulants (OACs) for stroke reduction in atrial fibrillation (AF) varies by race and geography within the United States. We seek to better understand the relationship between OAC underutilization, race, and US geography.
Patients with AF were selected from the US Centers for Medicare & Medicaid Services claims database from January 1, 2013, to December 31, 2016. The final population consisted of patients with 12 months of health plan enrollment before and after their index AF diagnosis, with a baseline CHAD2S2-VASc ≥2 and of either Black or White race (other races are underrepresented in the data). Among those with AF that met the inclusion criteria, patients who were prescribed warfarin or DOACs within 12 months after the index date were extracted. Each patient was assigned to a US county based on their 5-digit zip code and OAC use was stratified by race. Statistically significant differences were determined by student's t-test and chi-square.
Of the 2,390,830 final patients, 94.1% were White and 5.9% were Black patients. Mean (SD) age and HASBLED scores were 78 (9) and 3.9 (1.2) respectively, for Black patients and 80 (9) and 3.3 (1.2), respectively, for White patients (p<0.0001). The mean (SD) CHAD2S2-VASc scores were 4.5 (1.9) for White patients, and 5.3 (1.9) for Black patients with p<0.0001, respectively. Black patients (vs White patients) had a higher non-treatment (no DOAC or warfarin) rate (56.1% vs 47.4%, p<0.0001) across the US which was particularly notable in the southeast. In addition, treatment rates were highly variable within each US state. Counties with dense population more frequently demonstrated significant differences by race than counties with sparse population.
Our study showed differences in the use of OACs across US counties and among various racial groups. These disparities highlighted the areas of unmet need for both Black and White patients.
在美国，口服抗凝药（OACs）用于降低房颤（AF）患者中风风险的情况因种族和地域而异。我们旨在更好地了解OAC使用不足与种族及美国地域之间的关系。
从美国医疗保险和医疗补助服务中心（CMS）2013年1月1日至2016年12月31日的索赔数据库中选取房颤患者。最终研究人群包括在索引房颤诊断前后各有12个月健康计划参保记录的患者，基线CHAD2S2-VASc评分≥2，且为黑人或白人种族（数据中其他种族代表性不足）。在符合纳入标准的房颤患者中，提取索引日期后12个月内开具华法林或直接口服抗凝药（DOACs）的患者。根据患者的5位邮政编码将每位患者分配到美国的一个县，并按种族对OAC使用情况进行分层。通过学生t检验和卡方检验确定统计学上的显著差异。
在2390830名最终患者中，94.1%为白人，5.9%为黑人患者。黑人患者的平均（标准差）年龄和HASBLED评分分别为78（9）和3.9（1.2），白人患者分别为80（9）和3.3（1.2）（p<0.0001）。白人患者的平均（标准差）CHAD2S2-VASc评分为4.5（1.9），黑人患者为5.3（1.9），p<0.0001。在美国，黑人患者（与白人患者相比）的未治疗（未使用DOAC或华法林）率更高（56.1%对47.4%，p<0.0001），在东南部尤为明显。此外，美国每个州内的治疗率差异很大。人口密集的县比人口稀少的县在种族方面更频繁地表现出显著差异。
我们的研究表明，美国各县以及不同种族群体在OAC使用方面存在差异。这些差异凸显了黑人和白人患者未满足需求的领域。
