Abstract 070: Area Deprivation Index Is Associated With Oral Anticoagulation Provision In Incident Atrial Fibrillation

Abstract

Introduction: Oral anticoagulation (OAC) is a standard of care for stroke prevention in individuals with atrial fibrillation (AF). Social determinants of health have had limited investigation in AF and particularly in relation to OAC. We examined the effect of area deprivation index (ADI) on OAC prescription and agent selection (warfarin or direct-acting OAC). Hypotheses: (1) Individuals with AF living in neighborhoods with higher ADI (i.e., higher deprivation), are less likely to receive OAC for stroke prevention than those living in neighborhoods with lower ADI. (2) Among those prescribed OAC, those living in neighborhoods with higher ADI are more likely to receive warfarin as opposed to direct OAC. Methods: We conducted a retrospective analysis of patients with incident, non-valvular AF from 2015-2020 receiving care at a large, regional health center. We extracted demographics, medications, and problem lists and used administrative coding to identify comorbid conditions and relevant covariates, and the Zip+4 to ascertain ADI. We examined the relation between ADI and OAC prescription and selection at 90 days following the AF diagnosis in multivariable-adjusted models. Results: Following exclusions, the dataset included 20,210 individuals (age 74.5±10.9 years; 51% (10,270 of 20,210) women; 94% (19,053 of 20,210) white race. Individuals in the highest quartile of ADI were 13% less likely to receive OAC than those in the lowest quartile (adjusted Odds Ratio [OR] 0.87; 95% Confidence Interval [CI], 0.77-0.98) at 90 days following AF diagnosis. In those receiving OAC, individuals in the highest quartile of ADI were 21% less likely to receive a more modern direct-acting OAC as opposed to warfarin compared to those in the lowest quartile (aOR 0.79; 95% CI, 0.63-0.99) at 90 days following AF diagnosis. Conclusions: We demonstrate the association of ADI with (1) access to OAC for stroke prevention in AF and (2) likelihood of treatment with a more contemporary direct-acting OAC (rather than warfarin). Our results suggest health inequities in the provision of anticoagulation for stroke prevention in AF in a large, regional health care system.