Objective:

To evaluate the association of patient-clinician race and language concordance with direct oral anticoagulant (DOAC) initiation and persistence in patients with atrial fibrillation (AF).

Approach:

• Study Design: Retrospective cohort study involving patients with AF treated within a large Southern California health system from 2012 to 2022.
• Outcomes Measured: DOAC initiation within 2 months of AF diagnosis and continuation of DOAC therapy during the first postdiagnosis year.

Key Findings:

• Race concordance was associated with a 19% higher rate of DOAC initiation (odds ratio [OR], 1.19; 95% CI, 1.14-1.24) and an 8% higher rate of DOAC persistence (OR, 1.08; 95% CI, 1.03-1.14).
• Language concordance was associated with a 14% higher rate of DOAC persistence (OR, 1.14; 95% CI, 1.04-1.24), but no difference in initiation was found.
• Hispanic patients showed associations for both race and language concordance with DOAC initiation and continuation, while no such associations were found for Black patients.
• Socioeconomic factors, including insurance type and neighborhood deprivation, significantly influenced DOAC use.

Interpretation:

Patient-clinician race and language concordance may influence medication use, but broader structural factors also play a critical role.

Limitations:

• The study did not explore the impact of other contextual factors beyond the patient-clinician relationship.
• Findings may not be generalizable to all healthcare settings or populations.

Conclusion:

Addressing structural determinants of health is essential for advancing pharmacoequity in AF care.

Sources:

• Au et al. Study