Gender and Socioeconomic Inequality in the Prescription of Direct Oral Anticoagulants in Patients with Non-Valvular Atrial Fibrillation in Primary Care in Catalonia (Fantas-TIC Study)

Gender and Socioeconomic Inequality in the Prescription of Direct Oral Anticoagulants in Patients with Non-Valvular Atrial Fibrillation in Primary Care in Catalonia (Fantas-TIC Study)

Background: Evidence points to unequal access to direct oral anticoagulant (DOAC) therapy, to the detriment of the most socioeconomically disadvantaged patients in different geographic areas; however, few studies have focused on people with atrial fibrillation. This study aimed to assess gender-base...

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Published in:International journal of environmental research and public health Vol. 18; no. 20; p. 10993
Main Authors: Dalmau Llorca, Mª Rosa, Aguilar Martín, Carina, Carrasco-Querol, Noèlia, Hernández Rojas, Zojaina, Forcadell Drago, Emma, Rodríguez Cumplido, Dolores, Castro Blanco, Elisabet, Pepió Vilaubí, Josep Mª, Gonçalves, Alessandra Queiroga, Fernández-Sáez, José
Format: Journal Article
Language:English
Published: Basel MDPI AG 19-10-2021
MDPI
Subjects:
Antagonists
Anticoagulants
Cardiac arrhythmia
Classification
Deprivation
Employment
Fibrillation
Gender
Health care
Hormone replacement therapy
Inequality
Narcotics
Patients
Population
Primary care
Rural areas
Social change
Sociodemographics
Socioeconomic factors
Socioeconomics
Statistical analysis
Stroke
Urban areas
Urban environments
Variables
Vitamin K
United States > US
Spain
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Summary:Background: Evidence points to unequal access to direct oral anticoagulant (DOAC) therapy, to the detriment of the most socioeconomically disadvantaged patients in different geographic areas; however, few studies have focused on people with atrial fibrillation. This study aimed to assess gender-based and socioeconomic differences in the prescriptions of anticoagulants in people with non-valvular atrial fibrillation who attended Primary Care. Method: A cross-sectional study with real-world data from patients treated in Primary Care in Catalonia (Spain). Data were obtained from the SIDIAP database, covering 287 Primary Care centers in 2018. Results were presented as descriptive statistics and odds ratios estimated by multivariable logistic regression. Results: A total of 60,978 patients on anticoagulants for non-valvular atrial fibrillation were identified: 41,430 (68%) were taking vitamin K antagonists and 19,548 (32%), DOACs. Women had higher odds of treatment with DOAC (adjusted odds ratio [ORadj] 1.12), while lower DOAC prescription rates affected patients from Primary Care centers located in high-deprivation urban centers (ORadj 0.58) and rural areas (ORadj 0.34). Conclusions: DOAC prescription patterns differ by population. Women are more likely to receive it than men, while people living in rural areas and deprived urban areas are less likely to receive this therapy. Following clinical management guidelines could help to minimize the inequality.
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Co-first author, these authors, M. Rosa Dalmau Llorca and Carina Aguilar Martín, contributed equally to this work.
Co-senior authors: M. Rosa Dalmau Llorca, Carina Aguilar Martín, Alessandra Queiroga Gonçalves and José Fernández-Sáez. M. Rosa Dalmau Llorca is the Principal Investigator of this study.
ISSN:1660-4601
1661-7827
1660-4601
DOI:10.3390/ijerph182010993