Abstract
BackgroundThe Swedish healthcare system aims to provide equal access to care to all residents yet evidence suggests that patients with low socioeconomic status are less likely to receive new drugs. Associations between sociodemographics and prescription of non-vitamin K antagonist oral anticoagulants (NOACs) as an alternative to warfarin in Sweden have not been investigated.MethodsWe conducted a cross-sectional study using linked national registers in Sweden. The study population included oral anticoagulant naïve patients aged ≥18 years with non-valvular atrial fibrillation (NVAF) who filled a first prescription for a NOAC or warfarin from 01 December 2011 to 31 December 2014. Multivariable logistic regression was used to identify factors associated with the choice of anticoagulant treatment; adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.ResultsAmong 68,056 patients with NVAF, 27.4% (N = 18,638) started treatment with a NOAC and 72.6% (N = 49,418) started on warfarin. Patients starting treatment with a NOAC were more likely to be highly educated (OR 1.37, 95% CI: 1.30–1.45), in the highest income quartile (OR 1.23, 95% CI: 1.16–1.31) and have a leading professional occupation (OR 1.41, 95% CI: 1.27–1.58). Patients residing in rural areas were half as likely to start treatment with a NOAC as those in urban areas (OR 0.48, 95% CI: 0.45–0.51).ConclusionAmong Swedish patients with NVAF, those with high socioeconomic status and urban residence were more likely to start preventative treatment with a NOAC than warfarin. Future research should explore reasons for these inequalities in NOAC treatment.
Highlights
The study population comprised of 68,056 patients with a diagnosis of non-valvular atrial fibrillation (NVAF) and a first prescription for a non-vitamin K antagonist oral anticoagulants (NOACs) or warfarin
Patients receiving a NOAC as first anticoagulant therapy were less likely to live in rural areas of Sweden than patients started on warfarin (10.2% vs. 19.0%), and were more likely to have post-secondary education (≥9 years; 25.7% vs. 20.2%), to be in employment (26.1% vs. 21.3%), have higher clerk/ leading position jobs (4.6% vs. 2.8%), have qualified white-collar jobs (5.8% vs. 4.2%) and have a higher income
The results of our large population-based study in Sweden indicate that geographical location and several sociodemographic factors are associated with receiving treatment the newer NOACs rather than warfarin for stroke prevention
Summary
Since 2011, non-vitamin K antagonist oral anticoagulants (NOACs) – dabigatran, rivaroxaban and apixaban – have been available in Sweden as alternatives to warfarin for stroke prevention in atrial fibrillation (AF) and other indications More expensive, this new class of drugs have more favourable benefit–risk profiles than warfarin [9–11] and can be prescribed in fixed doses without routine monitoring of coagulation. [13] We used data from linked national registers for the period 2011 to 2014 to investigate associations between sociodemographic factors and initial treatment with a NOAC (vs warfarin, the previous standard of care) in oral anticoagulant naïve patients with non-valvular atrial fibrillation (NVAF) To our knowledge, this relationship has not previously been investigated in Sweden, and findings may be relevant for other currently available new drugs compared with the standard of care. Associations between sociodemographics and prescription of non-vitamin K antagonist oral anticoagulants (NOACs) as an alternative to warfarin in Sweden have not been investigated
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