Black race was associated with a lower likelihood of receiving a direct oral anticoagulant for incident venous thromboembolism compared with white race (OR 0.86; 95% CI 0.77-0.97; P=0.02).
Cohort (n=14,140)
Are racial, ethnic, and socioeconomic factors associated with the prescription of direct oral anticoagulants in patients with incident venous thromboembolism?
Black race and lower household income are associated with significantly lower use of direct oral anticoagulants for incident venous thromboembolism, highlighting racial and socioeconomic inequities in access to novel pharmacotherapies.
Effect estimate: OR 0.86 (95% CI 0.77-0.97)
p-value: p=0.02
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.
Nathan et al. (Mon,) conducted a cohort in venous thromboembolism (n=14,140). Black race vs. White race was evaluated on Use of direct oral anticoagulants (DOACs) (OR 0.86, 95% CI 0.77-0.97, p=0.02). Black race was associated with a lower likelihood of receiving a direct oral anticoagulant for incident venous thromboembolism compared with white race (OR 0.86; 95% CI 0.77-0.97; P=0.02).