Racial and Linguistic Alignment Between Patients and Clinicians: Implications for Pharmacoequity

By
Grecia B. Vargas Meléndez
Michelle S. Keller
Utibe R. Essien
September 10, 2026

Jama Network Open

Overview

This study investigates the impact of patient-clinician race and language concordance on the initiation and persistence of direct oral anticoagulant (DOAC) therapy in patients with atrial fibrillation (AF). Findings indicate that race concordance is associated with a 19% higher rate of DOAC initiation and an 8% higher rate of persistence, while language concordance is linked to a 14% higher rate of persistence.

Background

Atrial fibrillation (AF) is a prevalent heart rhythm disorder affecting millions in the US, with oral anticoagulant therapy being a key strategy to reduce stroke risk. Despite guideline recommendations for direct oral anticoagulants (DOACs), significant racial and ethnic disparities in treatment outcomes persist. Understanding the role of patient-clinician relationships in pharmacoequity is crucial for addressing these disparities.

Data Highlights

Outcome	Effect of Race Concordance	Effect of Language Concordance
DOAC Initiation	19% higher (OR 1.19; 95% CI 1.14-1.24)	No difference
DOAC Persistence	8% higher (OR 1.08; 95% CI 1.03-1.14)	14% higher (OR 1.14; 95% CI 1.04-1.24)

Key Findings

Race concordance is associated with a 19% higher rate of DOAC initiation.
Race concordance is associated with an 8% higher rate of DOAC persistence.
Language concordance is linked to a 14% higher rate of DOAC persistence.
Socioeconomic factors significantly influence DOAC use among patients with AF.
Commercially insured patients have 73% greater odds of initiating DOAC therapy compared to Medicare beneficiaries.
Medicaid-insured patients have 24% lower odds of maintaining DOAC therapy at 1 year.

Clinical Implications

The findings indicate that race and language concordance between patients and clinicians are associated with differences in medication initiation and persistence in AF management.

Conclusion

Patient-clinician concordance in race and language may influence the management of AF, but broader structural determinants that influence treatment access and adherence should also be considered.