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Socioeconomic inequality in oral anticoagulation therapy initiation in patients with atrial fibrillation with high risk of stroke: a register-based observational study

OBJECTIVE: The study aimed to examine the association between socioeconomic factors (SEFs) and oral anticoagulation (OAC) therapy and whether it was influenced by changing guidelines. We hypothesised that inequities in initiation of OAC reduced over time as more detailed and explicit clinical guidel...

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Autores principales: Lunde, Elin Danielsen, Joensen, Albert Marni, Fonager, Kirsten, Lundbye-Christensen, Søren, Johnsen, Søren Paaske, Larsen, Mogens Lytken, Lip, Gregory YH, Riahi, Sam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8169491/
https://www.ncbi.nlm.nih.gov/pubmed/34059516
http://dx.doi.org/10.1136/bmjopen-2021-048839
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author Lunde, Elin Danielsen
Joensen, Albert Marni
Fonager, Kirsten
Lundbye-Christensen, Søren
Johnsen, Søren Paaske
Larsen, Mogens Lytken
Lip, Gregory YH
Riahi, Sam
author_facet Lunde, Elin Danielsen
Joensen, Albert Marni
Fonager, Kirsten
Lundbye-Christensen, Søren
Johnsen, Søren Paaske
Larsen, Mogens Lytken
Lip, Gregory YH
Riahi, Sam
author_sort Lunde, Elin Danielsen
collection PubMed
description OBJECTIVE: The study aimed to examine the association between socioeconomic factors (SEFs) and oral anticoagulation (OAC) therapy and whether it was influenced by changing guidelines. We hypothesised that inequities in initiation of OAC reduced over time as more detailed and explicit clinical guidelines were issued. DESIGN: Register-based observational study. SETTINGS: All Danish patients with an incident hospital diagnosis of atrial fibrillation (AF), aged ≥30 years old and with high risk of stroke from 1 May 1999 to 2 October 2015 were included. Absolute risk differences (RD) (95% CI) were used to measure the association. PARTICIPANTS: 154 448 patients (mean age 78.2 years, men 47.3%). EXPOSURE: Education, family income and cohabiting status were the SEFs used as exposure. OUTCOME: A prescription of OAC within −30 to +90 days of baseline (incident AF). RESULTS: During 2002–2007, the crude RD of initiation of OAC for men with high education was 14.9% (12.8 to 16.9). Inequality reduced when new guidelines were published, and in 2013–2016 the crude RD was 5.6% (3.5 to 7.7). After adjusting for age, the RD substantially reduced. The same pattern was seen for cohabiting status, while inequality was smaller and more constant for income. CONCLUSION: Patients with low income, low education and living alone were associated with lower chance of being initiated with OAC. For education and cohabiting status, the crude difference reduced around 2011, when more detailed clinical guidelines were implemented in Denmark. Our results indicate that new guidelines might reduce inequality in OAC initiation and that new, high-cost drugs increase inequality.
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spelling pubmed-81694912021-06-17 Socioeconomic inequality in oral anticoagulation therapy initiation in patients with atrial fibrillation with high risk of stroke: a register-based observational study Lunde, Elin Danielsen Joensen, Albert Marni Fonager, Kirsten Lundbye-Christensen, Søren Johnsen, Søren Paaske Larsen, Mogens Lytken Lip, Gregory YH Riahi, Sam BMJ Open Cardiovascular Medicine OBJECTIVE: The study aimed to examine the association between socioeconomic factors (SEFs) and oral anticoagulation (OAC) therapy and whether it was influenced by changing guidelines. We hypothesised that inequities in initiation of OAC reduced over time as more detailed and explicit clinical guidelines were issued. DESIGN: Register-based observational study. SETTINGS: All Danish patients with an incident hospital diagnosis of atrial fibrillation (AF), aged ≥30 years old and with high risk of stroke from 1 May 1999 to 2 October 2015 were included. Absolute risk differences (RD) (95% CI) were used to measure the association. PARTICIPANTS: 154 448 patients (mean age 78.2 years, men 47.3%). EXPOSURE: Education, family income and cohabiting status were the SEFs used as exposure. OUTCOME: A prescription of OAC within −30 to +90 days of baseline (incident AF). RESULTS: During 2002–2007, the crude RD of initiation of OAC for men with high education was 14.9% (12.8 to 16.9). Inequality reduced when new guidelines were published, and in 2013–2016 the crude RD was 5.6% (3.5 to 7.7). After adjusting for age, the RD substantially reduced. The same pattern was seen for cohabiting status, while inequality was smaller and more constant for income. CONCLUSION: Patients with low income, low education and living alone were associated with lower chance of being initiated with OAC. For education and cohabiting status, the crude difference reduced around 2011, when more detailed clinical guidelines were implemented in Denmark. Our results indicate that new guidelines might reduce inequality in OAC initiation and that new, high-cost drugs increase inequality. BMJ Publishing Group 2021-05-30 /pmc/articles/PMC8169491/ /pubmed/34059516 http://dx.doi.org/10.1136/bmjopen-2021-048839 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Cardiovascular Medicine
Lunde, Elin Danielsen
Joensen, Albert Marni
Fonager, Kirsten
Lundbye-Christensen, Søren
Johnsen, Søren Paaske
Larsen, Mogens Lytken
Lip, Gregory YH
Riahi, Sam
Socioeconomic inequality in oral anticoagulation therapy initiation in patients with atrial fibrillation with high risk of stroke: a register-based observational study
title Socioeconomic inequality in oral anticoagulation therapy initiation in patients with atrial fibrillation with high risk of stroke: a register-based observational study
title_full Socioeconomic inequality in oral anticoagulation therapy initiation in patients with atrial fibrillation with high risk of stroke: a register-based observational study
title_fullStr Socioeconomic inequality in oral anticoagulation therapy initiation in patients with atrial fibrillation with high risk of stroke: a register-based observational study
title_full_unstemmed Socioeconomic inequality in oral anticoagulation therapy initiation in patients with atrial fibrillation with high risk of stroke: a register-based observational study
title_short Socioeconomic inequality in oral anticoagulation therapy initiation in patients with atrial fibrillation with high risk of stroke: a register-based observational study
title_sort socioeconomic inequality in oral anticoagulation therapy initiation in patients with atrial fibrillation with high risk of stroke: a register-based observational study
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8169491/
https://www.ncbi.nlm.nih.gov/pubmed/34059516
http://dx.doi.org/10.1136/bmjopen-2021-048839
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