Association of income and educational levels on initiation of oral anticoagulant therapy in patients with incident atrial fibrillation: A Finnish nationwide cohort study

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Journal Title
Journal ISSN
Volume Title
A1 Alkuperäisartikkeli tieteellisessä aikakauslehdessä
Date
2023-01
Major/Subject
Mcode
Degree programme
Language
en
Pages
10
351-360
Series
British Journal of Clinical Pharmacology, Volume 89, issue 1
Abstract
Aims: Socioeconomic disparities have been reported in the outcomes of patients with atrial fibrillation (AF). We assessed the hypothesis that AF patients with higher income or educational level are more frequently initiated with oral anticoagulant (OAC) therapy for stroke prevention. Methods: The nationwide registry-based Finnish AntiCoagulation in Atrial Fibrillation cohort covers all patients with AF from all levels of care in Finland. Patients were divided into income quartiles according to their highest annual income during 2004-2018 and into three categories based on educational attainment. The outcome was the first redeemed OAC prescription. Results: We identified 239 222 patients (mean age 72.7 ± 13.2 years, 49.8% female) with incident AF during 2007-2018. Higher income was associated with higher OAC initiation rate: compared to the lowest income quartile the adjusted SHRs (95% CI) for OAC initiation were 1.09 (1.07-1.10), 1.13 (1.11-1.14) and 1.13 (1.12-1.15) in the second, third and fourth income quartiles, respectively. Patients in the highest educational category had a slightly lower OAC initiation rate than patients in the lowest educational category (adjusted SHR 0.92 [95% CI 0.90-0.93]). Income-related disparities were larger and education-related disparities only marginal among patients at high risk of ischemic stroke. The socioeconomic disparities in OAC initiation within 1-year follow-up decreased from 2007 to 2018. The adoption of direct OACs as the initial anticoagulant was faster among patients with higher income or educational levels. Conclusion: These findings highlight potential missed opportunities in stroke prevention, especially among AF patients with low income, whereas the education-related disparities in OAC initiation appear controversial.
Description
Funding Information: Konsta Teppo, Jussi Jaakkola, Fausto Biancari and Olli Halminen: none. Jukka Putaala: personal fees from Boehringer‐Ingelheim, personal fees and other from Bayer, grants and personal fees from BMS‐Pfizer, personal fees from Portola, other from Amgen, personal fees from Herantis Pharma, personal fees from Terve Media, other from Vital Signum and personal fees from Abbott, outside the submitted work. Pirjo Mustonen: consultant at Roche, BMS‐Pfizer Alliance, Novartis Finland, Boehringer Ingelheim and MSD Finland. Jari Haukka: consultant at Research Janssen R&D and speaker at Bayer Finland. Miika Linna: speaker at BMS‐Pfizer Alliance, Bayer and Boehringer‐Ingelheim. Juha Hartikainen: research grants from the Finnish Foundation for Cardiovascular Research, EU Horizon 2020 and EU FP7, Advisory Board Member at BMS‐Pfizer Alliance, Novo Nordisk and Amgen, speaker at Cardiome and Bayer. K.E. Juhani Airaksinen: research grants from the Finnish Foundation for Cardiovascular Research, speaker at Bayer, Pfizer and Boehringer‐Ingelheim, member of the advisory boards of Bayer, Pfizer and AstraZeneca. Mika Lehto: consultant at BMS‐Pfizer Alliance, Bayer, Boehringer‐Ingelheim and MSD, speaker at BMS‐Pfizer Alliance, Bayer, Boehringer Ingelheim, MSD, Terve Media and Orion Pharma, research grants from the Aarne Koskelo Foundation, the Finnish Foundation for Cardiovascular Research, the Helsinki and Uusimaa Hospital District research fund and Boehringer‐Ingelheim. Funding Information: This work was supported by the Aarne Koskelo Foundation, the Finnish Foundation for Cardiovascular Research, and Helsinki and Uusimaa Hospital District research fund. The funders had no role in the design and conduct of the study, collection, management, analysis and interpretation of the data, preparation, review or approval of the manuscript, or the decision to submit the manuscript for publication. Publisher Copyright: © 2022 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.
Keywords
atrial fibrillation, education, income, oral anticoagulation, socioeconomic factors, stroke prevention
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Citation
Teppo , K , Jaakkola , J , Biancari , F , Halminen , O , Linna , M , Haukka , J , Putaala , J , Mustonen , P , Kinnunen , J , Hartikainen , J , Airaksinen , K E J & Lehto , M 2023 , ' Association of income and educational levels on initiation of oral anticoagulant therapy in patients with incident atrial fibrillation: A Finnish nationwide cohort study ' , British Journal of Clinical Pharmacology , vol. 89 , no. 1 , pp. 351-360 . https://doi.org/10.1111/bcp.15501