Racial, ethnic, and socioeconomic inequities in the prescription of direct oral anticoagulants in patients with venous thromboembolism in the United States.
Open accessAbstract
Background: Beginning in 2012, direct oral anticoagulants (DOACs) were approved for treatment and prevention of venous thromboembolism. 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 venous thromboembolism patients. Methods and Results: We performed a retrospective cohort analysis of adult patients with an incident diagnosis of venous thromboembolism 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 <0.1% in 2010 to 65.6% in 2016. In multivariable analyses, black patients were less likely to receive a DOAC compared with white patients (odds ratio, 0.86; 95% CI, 0.77–0.97; P =0.02). There were no differences in DOAC utilization among Asian (odds ratio, 1.06; 95% CI, 0.75–1.49; P =0.74) or Hispanic patients (odds ratio, 1.04; 95% CI, 0.88–1.22; P =0.66) compared with whites. Patients with a household income over $100 000 per year were more likely to receive DOAC therapy compared with patients with a household income of <$40 000 per year (odds ratio, 1.50; 95% CI, 1.33–1.69; P <0.0001). Conclusions: 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 venous thromboembolism 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.
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Historically, there has been decreased adoption of novel therapies among Black patients as well as among female patients and those with low socioeconomic status.
“Historically, there has been decreased adoption of novel therapies among Black patients as well as among female patients and those with low socioeconomic status.25,26,27”
From Association of race/ethnicity, gender, and socioeconomic status with sodium-glucose cotransporter 2 inhibitor use among patients with diabetes in the US (2021) · cites this paper as [26]
These results are consistent with those of several prior studies that have shown decreased use of novel therapeutics among Black patients.
“These results are consistent with those of several prior studies25,26,27 that have shown decreased use of novel therapeutics among Black patients.”
From Association of race/ethnicity, gender, and socioeconomic status with sodium-glucose cotransporter 2 inhibitor use among patients with diabetes in the US (2021) · cites this paper as [26]
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“Zip code–level household data are commonly used in Medicare studies.(18,22) In conclusion, we identified several race-, sex-, and agerelated disparities in use of SGLT2i and GLP-1RA among Medicare-insured adults diagnosed with type 2 diabetes and CKD.”
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- Authors
- Nathan, A. S., Geng, Z., Dayoub, E. J., Khatana, S. A. M., Eberly, L. A., Kobayashi, T., Pugliese, S. C., Adusumalli, S., Giri, J., & Groeneveld, P. W.
- Affiliations
- Hospital of the University of Pennsylvania (US)
- Leonard Davis Institute of Health Economics (US)
- Philadelphia VA Medical Center (US)
- Brigham and Women's Hospital (US)
- University of Pennsylvania (US)
- ORCID
- Venue
- Circulation: Cardiovascular Quality and Outcomes
- Published
- 2019-04
- Volume
- 12
- Issue
- 4
- Pages
- e005600-e005600
- ISSN
- 1941-7705 (ISSN-L)
- 1941-7713
- PMC
- PMC9119738
- OpenAlex
- W2933741778
- Cited by
- 67
- References
- 32
- Citations by year
- 2026: 3 · 2025: 14 · 2024: 8 · 2023: 7 · 2022: 13 · 2021: 13 · 2020: 8 · 2019: 1
- FWCI
- 6.71
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Circulation Cardiovascular Quality and Outcomes (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (K23HL153772)
- Topics
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Social Sciences › Health › Health disparities and outcomes
- Keywords
- direct oral anticoagulants, venous thromboembolism, racial disparities, ethnic disparities, socioeconomic disparities, Black patients, household income, commercially insured patients, health equity, post-discharge prescribing, Asian patients, Hispanic patients, Caucasian patients, United States
- MeSH terms
- Administration, Oral, Adult, Aged, Asian, Black or African American, Female, Health Services Accessibility, Hispanic or Latino, Humans, Income, Male, Middle Aged, Retrospective Studies, Risk Factors, Socioeconomic Factors, Time Factors, United States, Incidence, Databases, Factual, Treatment Outcome, Risk Assessment, White People, Venous Thromboembolism, Healthcare Disparities, Social Determinants of Health, Factor Xa Inhibitors
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