Racial, Ethnic, and Socioeconomic Inequities in the Prescription of Direct Oral Anticoagulants in Patients With Venous Thromboembolism in the United States.
Racial, Ethnic, and Socioeconomic Inequities in the Prescription of Direct Oral Anticoagulants in Patients With Venous Thromboembolism in the United States.
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DOI：
10.1161/circoutcomes.119.005600
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发表时间：
2019-04
影响因子：
6.9
通讯作者：
Groeneveld, Peter W.
中科院分区：
文献类型：
--
作者：
Nathan, Ashwin S.;Geng, Zhi;Dayoub, Elias J.;Khatana, Sameed Ahmed M.;Eberly, Lauren A.;Kobayashi, Taisei;Pugliese, Steven C.;Adusumalli, Srinath;Giri, Jay;Groeneveld, Peter W.
从 2012 年开始，直接口服抗凝剂 (DOAC) 被批准用于治疗和预防 VTE。先前的调查表明，黑人患者采用新疗法的速度缓慢。我们评估了商业保险 VTE 患者中种族/民族和社会经济因素与 DOAC 使用的关联。我们使用 OptumInsight 的临床信息学数据集市对 2010 年 1 月至 2016 年 12 月期间诊断为 VTE 的成年患者进行了回顾性队列分析。我们在患者出院后 30 天内确定了第一份口服抗凝药处方。我们进行了多变量逻辑回归，调整了年龄、性别、种族/民族、地区、邮政编码相关的家庭收入和临床协变量，以确定与使用 DOAC 相关的因素。该数据库中的种族和族裔是通过公共记录、自我报告和专有种族代码表的组合来确定的。分析中纳入了 14,140 名患者。 DOAC 治疗从 2010 年的不到 0.1% 增加到 2016 年的 65.6%。在多变量分析中，与白人患者相比，黑人患者接受 DOAC 的可能性较小（OR 0.86，95% CI 0.77 – 0.97，p=0.02）。与白人相比，亚洲人（OR 1.06，95% CI 0.75 – 1.49，p=0.74）或西班牙裔患者（OR 1.04，95% CI 0.88 – 1.22，p=0.66）的 DOAC 使用率没有差异。与家庭年收入低于 40,000 美元的患者相比，家庭年收入超过 100,000 美元的患者更有可能接受 DOAC 治疗（OR 1.50，95% CI 1.33 – 1.69，p<0.0001）。尽管自 2012 年以来 DOAC 的采用率稳步上升，但在商业保险人群中，尽管控制了其他临床和社会经济因素，但黑人种族和家庭收入低与 DOAC 治疗 VTE 事件的使用率较低有关。这些发现表明在获得这种新型药物疗法方面可能存在种族和社会经济不平等。
Beginning in 2012 direct oral anticoagulants (DOACs) were approved for treatment and prevention of VTE. Prior investigations have demonstrated slow rates of adoption of novel therapeutics for black patients. We assessed the association of racial/ethnic and socioeconomic factors with DOAC use among commercially-insured VTE patients. We performed a retrospective cohort analysis of adult patients with an incident diagnosis of VTE between January 2010 and December 2016 using OptumInsight’s Clinformatics Data Mart. We identified the first filled oral anticoagulant prescription within 30 days of discharge of an inpatient admission. We performed a multivariable logistic regression, adjusting for age, sex, race/ethnicity, region, zip-code linked household income, and clinical covariates to identify factors associated with the use of DOACs. Race and ethnicity were determined in this database through a combination of public records, self-report, and proprietary ethnicity code tables. There were 14,140 patients included in the analysis. Treatment with DOACs increased from less than 0.1% in 2010 to 65.6% in 2016. In multivariable analyses black patients were less likely to receive a DOAC compared to white patients (OR 0.86, 95% CI 0.77 – 0.97, p=0.02). There were no differences in DOAC utilization among Asian (OR 1.06, 95% CI 0.75 – 1.49, p=0.74) or Hispanic patients (OR 1.04, 95% CI 0.88 – 1.22, p=0.66) compared to whites. Patients with a household income over $100,000 per year were more likely to receive DOAC therapy compared to patients with a household income of less than $40,000 per year (OR 1.50, 95% CI 1.33 – 1.69, p<0.0001). Although DOAC adoption has increased steadily since 2012, among a commercially-insured population, black race and low household income were associated with lower use of DOACs for incident VTE despite controlling for other clinical and socioeconomic factors. These findings suggest the possibility of both racial and socioeconomic inequity in access to this novel pharmacotherapy.