Key result
Higher neighborhood social barriers linked to ~10% lower odds of AF diagnosis in Black patients.
Why the study?
Early diagnosis and treatment of AF are critical for preventing stroke, heart failure, and mortality. Evaluating the interactions between race and ethnicity and neighborhood social determinants of health on AF diagnosis and treatment may improve detection and reduce disparities.
Does the interaction between race and ethnicity and neighborhood-level social determinants of health affect atrial fibrillation diagnosis and anticoagulant treatment in commercially insured and Medicare Advantage adults?
Cohort (n=504,876)
Does the interaction between race and ethnicity and neighborhood-level social determinants of health affect atrial fibrillation diagnosis and anticoagulant treatment in commercially insured and Medicare Advantage adults?
Atrial fibrillation diagnosis rates decline with worsening neighborhood-level social disadvantage among non-Hispanic Black individuals while increasing among non-Hispanic White individuals, highlighting the need for targeted AF detection interventions in marginalized neighborhoods.
Answers are grounded in this paper and cite their sources.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“These findings highlight the need for clinical interventions that extend beyond basic patient-level risk stratification”
“Amagai and colleagues shift the equity question in [AFib] from 'Who receives treatment?' to an earlier question: 'Who gets diagnosed?' If the observed differences partly reflect unequal opportunities for [AFib] recognition, then equal treatment after diagnosis is not enough”
“If the observed differences partly reflect unequal opportunities for [AFib] recognition, then equal treatment after diagnosis is not enough," write Kamala P. Tamirisa, MD, FACC, and Larry R. Jackson II, MD, MHSc, FACC, in an accompanying editorial. "Equity in [AFib] care must begin with equitable opportunities to detect the arrhythmia.”
Racial disparities in AF diagnosis may widen with neighborhood disadvantage; leaves open whether targeted screening improves equity.
Importance Early diagnosis and treatment of atrial fibrillation (AF) is critical for preventing stroke, heart failure, and mortality. Understanding patterns in diagnosis and treatment of AF may improve detection and reduce disparities. Objective To evaluate the interactions between race and ethnicity and neighborhood social determinants of health on AF diagnosis and treatment. Design, Setting, and Participants Retrospective cohort study using administrative claims for greater Philadelphia, Pennsylvania, area residents aged 18 years or older from Independence Blue Cross from 2017 to 2021. Baseline characteristics were assessed in 2017, and participants were followed up from 2018 through 2021. Data were analyzed from October 2023 to July 2026. Exposures Exposures included Non-Hispanic Black race and ethnicity, neighborhood-level social determinants of health as measured by the social barrier index (SBI), and the interaction between the two. Main Outcomes and Measures The primary outcome was AF diagnosis ascertained from International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes. The secondary outcome was anticoagulant prescription among individuals with AF diagnoses as ascertained from pharmacy claims. Results Of the 504 876 patients included, the mean (SD) age was 48 (18) years; 267 596 (53.0%) were female; 67 362 (13.3%) non-Hispanic Black, and 437 514 (86.7%) were non-Hispanic White. A total of 27 249 patients (5.1%) were diagnosed with AF during the study period. Non-Hispanic Black patients were less likely to be diagnosed with AF compared with non-Hispanic White patients (odds ratio [OR], 0.91; 95% CI, 0.82-1.00). The relative difference increased with increased SBI (which denotes more vulnerable neighborhoods) as shown by a significant interaction between race and ethnicity and SBI (OR, 0.90; 95% CI, 0.86-0.95). Among those diagnosed with AF, 15 722 (58%) had an anticoagulant prescription. There was a significant interaction between race and ethnicity and SBI (OR, 1.10; 95% CI, 1.00-1.20), suggesting that filled prescription patterns differed by race and ethnicity with SBI. For Black individuals one unit increase in SBI was associated with decreased odds of AF diagnosis (OR, 0.94; 95% CI, 0.90-0.99). For White individuals one unit increase in SBI was associated with increased odds of AF diagnosis (OR, 1.05; 95% CI, 1.03-1.07). Conclusions and Relevance This cohort study of Medicare Advantage and commercially insured individuals found that AF diagnosis rates declined with worsening neighborhood-level disadvantage among non-Hispanic Black individuals but increased among non-Hispanic White individuals. Conditional on diagnoses, rates of prescription of anticoagulants were similar across race and ethnicity groups. Targeted interventions, especially in more marginalized neighborhoods, are needed to increase detection of AF.
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Amagai et al. (2026) conducted a cohort in Atrial fibrillation (n=504,876). Non-Hispanic Black race and ethnicity and neighborhood social barrier index (SBI) vs. Non-Hispanic White race and ethnicity was evaluated on Atrial fibrillation diagnosis ascertained from ICD-10 diagnosis codes (OR 0.90, 95% CI 0.86-0.95). Non-Hispanic Black race interacted with higher neighborhood social barrier index to lower the odds of atrial fibrillation diagnosis compared with White patients (interaction OR 0.90; 95% CI 0.86-0.95).
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