Saturday, July 13, 2024

Racial and Ethnic Disparities in Anticoagulation Therapy: A VAMC Study

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Racial and ethnic disparities in healthcare remain a critical issue, affecting the quality and equity of treatments received by patients. A recent study has examined how the racial and ethnic composition of medical centers influences the initiation of anticoagulation therapy for atrial fibrillation (AF) within the Veterans Health Administration (VHA) system. This study sheds light on potential systemic inequities and the need for policy reforms to ensure fair treatment for all patients, regardless of their racial or ethnic backgrounds.

Study Design and Participants

The retrospective cohort study included 89,791 patients diagnosed with AF between 2018 and 2021 across 140 VHA medical centers. The majority of the cohort were male (97.6%) with an average age of 73.0 years. The racial and ethnic distribution consisted of 10.1% Black patients, 3.7% Hispanic patients, and 86.2% White patients. The study aimed to determine the association between the racial and ethnic composition of VHA centers and the initiation of anticoagulation therapy, including direct-acting oral anticoagulants (DOACs) and warfarin.

Findings and Disparities

The results indicated significant disparities in anticoagulation therapy initiation among different racial and ethnic groups. Overall, 72.1% of patients began any form of anticoagulation, with 67.2% starting on DOACs and 4.9% on warfarin. Black and Hispanic patients were less likely to initiate any anticoagulant or DOAC therapy compared to White patients but showed higher rates of warfarin initiation. Additionally, centers with a higher proportion of minoritized patients (quartile 4) had lower rates of anticoagulant initiation compared to those with fewer minoritized patients (quartile 1).

User-Usable Inferences

– Medical centers with diverse racial and ethnic compositions exhibit lower initiation rates for anticoagulation therapy.
– Black and Hispanic AF patients are less likely to receive DOACs compared to their White counterparts.
– Centers serving more minoritized patients exhibit significant disparities in the initiation of both any anticoagulant and warfarin therapy.

The study provides crucial insights into how racial and ethnic compositions of medical centers correlate with disparities in anticoagulation therapy for AF. Despite adjustments for sociodemographics, medical comorbidities, and facility factors, the findings underscore the need for targeted interventions to address these inequities. Interactions between patient race and ethnicity and medical center composition were not significant, suggesting that systemic factors contribute to these disparities.

In conclusion, the study highlights the persistent racial and ethnic disparities in anticoagulation therapy initiation in the VHA system. It calls for policy changes and focused strategies to ensure equitable healthcare access and treatment for all racial and ethnic groups.

Original Article: JAMA Netw Open. 2024 Jun 3;7(6):e2418114. doi: 10.1001/jamanetworkopen.2024.18114.

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