Laugesen Ina Grønkjær, Prior Anders, Bro Flemming, Mygind Anna, Grove Erik Lerkevang
Department of Public Health, Aarhus University, Aarhus, Denmark
Research Unit for General Practice, Aarhus, Denmark.
BMJ Open. 2025 May 24;15(5):e098129. doi: 10.1136/bmjopen-2024-098129.
To investigate temporal trends in the geographical variation in oral anticoagulant (OAC) treatment of patients with atrial fibrillation, to evaluate the extent to which regional differences in patient populations may explain this difference and to explore whether patient predictors of adherence may have a different impact across regions.
Register-based cohort study from 1 January 2013 to 31 December 2022.
The study used data from nationwide health registers to explore differences in OAC adherence across the five administrative regions in Denmark.
Patients with atrial fibrillation and a CHADS-VASc score ≥2 (n=291 666).
Population adherence to OAC treatment operationalised as the proportion of days covered (PDC).
A continuous rise in overall adherence (PDC) from 53% to 78% was observed during the study period. Concurrently, the predominant treatment shifted from vitamin K antagonists to direct OACs with a preference for rivaroxaban and apixaban. The adherence variation between the highest-performing and lowest-performing regions decreased from 18% in 2013 to 9% in 2022, whereas the relative between-regions rankings remained unchanged. Applying multivariate Poisson models adjusting for patient demographics, health status and socioeconomic factors did not substantially change the inter-regional variations; this suggests that different compositions of patient populations cannot explain these variations. However, the impact of socioeconomic factors and comorbidities among patients was unequal across regions. In regions with the lowest overall adherence, a higher risk of non-adherence was seen among patients having mental health disorders, low income and living alone.
The geographical variation in OAC adherence decreased over time as the overall adherence improved. However, substantial variation remained.
调查房颤患者口服抗凝药（OAC）治疗的地理差异的时间趋势，评估患者群体的区域差异在多大程度上可以解释这种差异，并探讨依从性的患者预测因素在不同地区是否可能产生不同影响。
基于登记的队列研究，时间跨度为2013年1月1日至2022年12月31日。
该研究使用全国健康登记数据，探讨丹麦五个行政区OAC依从性的差异。
房颤且CHADS-VASc评分≥2的患者（n = 291666）。
将人群对OAC治疗的依从性定义为覆盖天数比例（PDC）。
在研究期间观察到总体依从性（PDC）从53%持续上升至78%。同时，主要治疗方法从维生素K拮抗剂转向直接OAC，其中利伐沙班和阿哌沙班更受青睐。表现最佳和最差地区之间的依从性差异从2013年的18%降至2022年的9%，而地区间的相对排名保持不变。应用多变量泊松模型对患者人口统计学、健康状况和社会经济因素进行调整后，区域间差异没有实质性变化；这表明不同的患者群体构成无法解释这些差异。然而，社会经济因素和患者合并症的影响在不同地区并不相同。在总体依从性最低的地区，患有精神疾病、低收入和独居的患者不依从风险更高。
随着总体依从性的提高，OAC依从性的地理差异随时间而减小。然而，仍存在显著差异。
