Association of Race and Ethnicity and Anticoagulation in Patients With Atrial Fibrillation Dually Enrolled in Veterans Health Administration and Medicare: Effects of Medicare Part D on Prescribing Disparities.

Autor:	Essien UR; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, PA (U.R.E., N.K., C.B.G., T.M.A.L., L.R.M.H., M.K.M., W.F.G., M.J.F.).; Division of General Internal Medicine (U.R.E., C.B.G., L.R.M.H., W.F.G., M.J.F.), University of Pittsburgh School of Medicine, PA., Kim N; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, PA (U.R.E., N.K., C.B.G., T.M.A.L., L.R.M.H., M.K.M., W.F.G., M.J.F.)., Magnani JW; Department of Medicine (J.W.M.), University of Pittsburgh School of Medicine, PA., Good CB; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, PA (U.R.E., N.K., C.B.G., T.M.A.L., L.R.M.H., M.K.M., W.F.G., M.J.F.).; Division of General Internal Medicine (U.R.E., C.B.G., L.R.M.H., W.F.G., M.J.F.), University of Pittsburgh School of Medicine, PA.; Centers for Value-Based Pharmacy Initiatives and High-Value Health Care, UPMC Health Plan, Pittsburgh, PA (C.B.G.)., Litam TMA; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, PA (U.R.E., N.K., C.B.G., T.M.A.L., L.R.M.H., M.K.M., W.F.G., M.J.F.)., Hausmann LRM; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, PA (U.R.E., N.K., C.B.G., T.M.A.L., L.R.M.H., M.K.M., W.F.G., M.J.F.).; Division of General Internal Medicine (U.R.E., C.B.G., L.R.M.H., W.F.G., M.J.F.), University of Pittsburgh School of Medicine, PA., Mor MK; Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, PA (M.K.M.)., Gellad WF; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, PA (U.R.E., N.K., C.B.G., T.M.A.L., L.R.M.H., M.K.M., W.F.G., M.J.F.).; Division of General Internal Medicine (U.R.E., C.B.G., L.R.M.H., W.F.G., M.J.F.), University of Pittsburgh School of Medicine, PA., Fine MJ; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, PA (U.R.E., N.K., C.B.G., T.M.A.L., L.R.M.H., M.K.M., W.F.G., M.J.F.).; Division of General Internal Medicine (U.R.E., C.B.G., L.R.M.H., W.F.G., M.J.F.), University of Pittsburgh School of Medicine, PA.
Jazyk:	angličtina
Zdroj:	Circulation. Cardiovascular quality and outcomes [Circ Cardiovasc Qual Outcomes] 2022 Feb; Vol. 15 (2), pp. e008389. Date of Electronic Publication: 2021 Nov 15.
DOI:	10.1161/CIRCOUTCOMES.121.008389
Abstrakt:	Background: Racial and ethnic disparities in anticoagulation exist in atrial fibrillation management in Medicare and the Veterans Health Administration, but the influence of dual Veterans Health Administration and Medicare enrollment is unclear. We compared anticoagulant initiation by race and ethnicity in dually enrolled patients and assessed the role of Medicare part D enrollment on anticoagulation disparities. Methods: We identified patients with incident atrial fibrillation (2014-2018) dually enrolled in Veterans Health Administration and Medicare. We assessed any anticoagulant initiation (warfarin or direct-acting oral anticoagulants [DOACs]) within 90 days of atrial fibrillation diagnosis and DOAC use among anticoagulant initiators. We modeled anticoagulant initiation, adjusting for patient, provider, and facility factors, including main effects for race and ethnicity and Medicare part D enrollment and an interaction term for these variables. Results: In 43 789 patients, 8.9% were Black, 3.6% Hispanic, and 87.5% White; 10.9% participated in Medicare part D. Overall, 29 680 (67.8%) patients initiated any anticoagulant, of whom 17 568 (59.2%) initiated DOACs. Lower proportions of Black (65.2%) than Hispanic (67.6%) or White (68.0%) patients initiated any anticoagulant ( P =0.001) and, lower proportions of Black (56.3%) and Hispanic (55.9%) than White (59.6%) patients ( P =0.001) initiated DOACs. Compared with White patients, Black patients had significantly lower initiation of any anticoagulant (adjusted odds ratio, 0.89 [95% CI, 0.82-0.97]). The adjusted odds ratios for DOAC initiation were significantly lower for Black (0.72 [95% CI, 0.65-0.81]) and Hispanic (0.84 [95% CI, 0.70-1.00]) than White patients. The interaction between race and ethnicity and Medicare part D enrollment was nonsignificant for any anticoagulant ( P =0.99) and DOAC ( P =0.27) therapies. Conclusions: In dually enrolled Veterans Health Administration and Medicare patients with atrial fibrillation, Black patients were less likely to initiate any anticoagulant, and Black and Hispanic patients were less likely to initiate DOACs. Medicare part D enrollment did not moderate the associations between race and ethnicity and anticoagulant therapies.
Databáze:	MEDLINE
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