Neighborhood disadvantage linked to lower AF diagnosis among Black patients

A retrospective claims cohort of 504,876 adults in the Philadelphia area examined atrial fibrillation (AF) diagnosis and anticoagulant prescriptions by race and neighborhood disadvantage from 2017 to 2021. AF diagnosis odds declined as neighborhood disadvantage increased among non-Hispanic Black patients, while they rose among non-Hispanic White patients.

AF diagnosis odds differed by race and neighborhood disadvantage.
Higher SBI was linked to lower diagnosis odds among Black patients.
58% of diagnosed participants had an anticoagulant prescription.
Claims data cannot establish causes or confirm medication use.

Researchers analyzed administrative claims from Independence Blue Cross for adults in the greater Philadelphia area. The retrospective cohort included 504,876 people aged 18 years or older, with baseline characteristics assessed in 2017 and follow-up from 2018 through 2021. The study examined AF diagnoses and, among people diagnosed with AF, anticoagulant prescriptions, in relation to race and ethnicity and a neighborhood social barrier index (SBI), with higher scores indicating greater vulnerability.

During follow-up, 27,249 participants (5.1%) received an AF diagnosis. Compared with non-Hispanic White patients, non-Hispanic Black patients had lower odds of diagnosis (OR, 0.91; 95% CI, 0.82-1.00). The association varied by neighborhood disadvantage: each one-unit SBI increase was associated with lower AF diagnosis odds among Black patients (OR, 0.94; 95% CI, 0.90-0.99) and higher odds among White patients (OR, 1.05; 95% CI, 1.03-1.07). Of those diagnosed, 15,722 (58%) had an anticoagulant prescription; prescription patterns showed a race-by-SBI interaction.

The findings point to disparities in AF detection across race and neighborhood context and support the authors’ call for targeted detection efforts in marginalized neighborhoods. The observational claims-based analysis cannot establish causes, and its findings may not generalize beyond this insured Philadelphia-area population. Prescription claims indicate filled prescriptions, not necessarily medication use.

In practice

In this insured Philadelphia-area cohort, AF diagnosis patterns differed by both race and neighborhood disadvantage: increasing SBI was associated with lower diagnosis odds among non-Hispanic Black patients and higher odds among non-Hispanic White patients. These findings identify a potential detection disparity and support attention to AF case-finding in marginalized neighborhoods, as the authors suggest. They do not establish that neighborhood disadvantage caused the differences or define an effective screening strategy; claims-based results from one insured population may not apply elsewhere.

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Source

JAMA Network Open: Race- and Neighborhood-Level Social Determinants of Health in Diagnosis and Treatment of Atrial Fibrillation ↗

This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.