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The Influence of Socioeconomic Status on Selection of Anticoagulation for Atrial Fibrillation

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  • Michelle Sholzberg
  • Tara Gomes
  • David N Juurlink
  • Zhan Yao
  • Muhammad M Mamdani
  • Andreas Laupacis

Abstract

Importance: Without third-party insurance, access to marketed drugs is limited to those who can afford to pay. We examined this phenomenon in the context of anticoagulation for patients with nonvalvular atrial fibrillation (NVAF). Objective: To determine whether, among older Ontarians receiving anticoagulation for NVAF, patients of higher socioeconomic status (SES) were more likely to switch from warfarin to dabigatran prior to its addition to the provincial formulary. Design, Setting and Participants: Population-based retrospective cohort study of Ontarians aged 66 years and older, between 2008 and 2012. Exposure: Socioeconomic status, as approximated by median neighborhood income. Main Outcomes and Measure: We identified two groups of older adults with nonvalvular atrial fibrillation: those who appeared to switch from warfarin to dabigatran after its market approval but prior to its inclusion on the provincial formulary (“switchers”), and those with ongoing warfarin use during the same interval (“non-switchers”). Results: We studied 34,797 patients, including 3183 “switchers” and 31,614 “non-switchers”. We found that higher SES was associated with switching to dabigatran prior to its coverage on the provincial formulary (p

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  • Michelle Sholzberg & Tara Gomes & David N Juurlink & Zhan Yao & Muhammad M Mamdani & Andreas Laupacis, 2016. "The Influence of Socioeconomic Status on Selection of Anticoagulation for Atrial Fibrillation," PLOS ONE, Public Library of Science, vol. 11(2), pages 1-12, February.
    • Handle: RePEc:plo:pone00:0149142
    DOI: 10.1371/journal.pone.0149142
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    References listed on IDEAS

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    1. Krieger, N., 1992. "Overcoming the absence of socioeconomic data in medical records: Validation and application of a census-based methodology," American Journal of Public Health, American Public Health Association, vol. 82(5), pages 703-710.
    2. Dunlop, Sheryl & Coyte, Peter C. & McIsaac, Warren, 2000. "Socio-economic status and the utilisation of physicians' services: results from the Canadian National Population Health Survey," Social Science & Medicine, Elsevier, vol. 51(1), pages 123-133, July.
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    Cited by:

    1. Mª Rosa Dalmau Llorca & Carina Aguilar Martín & Noèlia Carrasco-Querol & Zojaina Hernández Rojas & Emma Forcadell Drago & Dolores Rodríguez Cumplido & Elisabet Castro Blanco & Josep Mª Pepió Vilaubí &, 2021. "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)," IJERPH, MDPI, vol. 18(20), pages 1-12, October.

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