Low socioeconomic status and Arab ethnicity in Israeli AF patients were linked to ~25% higher death and stroke risks and ~12% lower anticoagulation use.
Do socioeconomic, ethnic, and geographic disparities impact the management and outcomes of patients with atrial fibrillation?
Significant socioeconomic, ethnic, and geographic disparities exist in the management and outcomes of atrial fibrillation in Israel, with marginalized groups experiencing lower anticoagulation rates and higher mortality and stroke risks.
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Abstract Background Atrial fibrillation (AF) is the most common arrhythmia, associated with increased morbidity, mortality, and healthcare burden. Studies from Europe and North America link lower socioeconomic status (SES), ethnic minorities, and rural residence to reduced anticoagulant use and worse outcomes. Purpose To evaluate management and outcomes of AF patients in Israel’s diverse population. Methods This historical population-based study used 'Clalit Health Services' database, including patients 21 years first diagnosed with AF between January 1, 2012, and January 1, 2022. Patients were stratified by socioeconomic status, ethnicity, and district. Primary outcomes were stroke and all-cause mortality; secondary outcomes included anticoagulation and ablation rates. Categorical variables were compared using chi-square or Fisher’s exact test, and continuous variables with t-tests, Mann-Whitney, ANOVA, or Kruskal-Wallis tests. Logistic regression assessed treatment likelihood, while Kaplan-Meier and Cox regression evaluated survival outcomes and hazard ratios Results The study included 75,668 patients with incident atrial fibrillation, of whom 12,115 (16%) had low SES. The median CHA₂DS₂-VASc score was similar across groups (4). In an age- and sex-adjusted model, low SES was associated with higher risks of death (HR 1.25, 95% CI 1.21–1.29) and stroke (HR 1.26, 95% CI 1.17–1.37), while high SES was linked to lower risks (death: HR 0.77, 95% CI 0.75–0.80; stroke: HR 0.76, 95% CI 0.70–0.82, p0.001). Low SES was also associated with lower odds of anticoagulation purchase at 3 months (OR 0.89, 95% CI 0.85–0.93) and 1 year (OR 0.88, 95% CI 0.84–0.92), while high SES was linked to higher odds. Jewish ethnicity was associated with reduced risks of stroke and mortality and higher anticoagulation purchase compared to Arab ethnicity. Compared to the Southern district, residence in most other districts was associated with lower hazards of death or stroke, with significant reductions in Haifa, Sharon, Jerusalem, Dan-Petach Tikva, and the Center. Conclusions Socioeconomic, ethnic, and geographic disparities influence the management and outcomes of AF patients in Israel, with lower SES and Arab ethnicity associated with reduced anticoagulation use and worse survival, while residence in most districts outside the South was linked to better outcomes.
Golan et al. (Sat,) reported a other. Low socioeconomic status and Arab ethnicity in Israeli AF patients were linked to ~25% higher death and stroke risks and ~12% lower anticoagulation use.