{"id":6461,"date":"2016-02-25T00:00:00","date_gmt":"2016-02-25T05:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/journal-articles\/the-influence-of-socioeconomic-status-on-selection-of-anticoagulation-for-atrial-fibrillation\/"},"modified":"2023-06-14T19:42:25","modified_gmt":"2023-06-14T23:42:25","slug":"the-influence-of-socioeconomic-status-on-selection-of-anticoagulation-for-atrial-fibrillation","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/the-influence-of-socioeconomic-status-on-selection-of-anticoagulation-for-atrial-fibrillation\/","title":{"rendered":"The influence of socioeconomic status on selection of anticoagulation for atrial fibrillation"},"content":{"rendered":"

Importance<\/strong> — Without third-party insurance, access to marketed drugs is limited to those who can afford to pay. We examined this phenomenon in the context of anticoagulation for patients with nonvalvular atrial fibrillation (NVAF).<\/p>\n

Objective<\/strong> — To determine whether, among older Ontarians receiving anticoagulation for NVAF, patients of higher socioeconomic status (SES) were more likely to switch from warfarin to dabigatran prior to its addition to the provincial formulary.<\/p>\n

Design, Setting and Participants<\/span> — Population-based retrospective cohort study of Ontarians aged 66 years and older, between 2008 and 2012.<\/p>\n

Exposure<\/strong> — Socioeconomic status, as approximated by median neighborhood income.<\/p>\n

Main Outcomes and Measure<\/span> — We identified two groups of older adults with nonvalvular atrial fibrillation: those who appeared to switch from warfarin to dabigatran after its market approval but prior to its inclusion on the provincial formulary (“switchers”), and those with ongoing warfarin use during the same interval (“non-switchers”).<\/p>\n

Results<\/strong> — We studied 34,797 patients, including 3183 “switchers” and 31,614 “non-switchers”. We found that higher SES was associated with switching to dabigatran prior to its coverage on the provincial formulary (p<0.0001). In multivariable analysis, subjects in the highest quintile were 50% more likely to switch to dabigatran than those in the lowest income quintile (11.3% vs. 7.3%; adjusted odds ratio 1.50; 95% CI 1.32 to 1.68). Following dabigatran’s addition to the formulary, the income gradient disappeared.<\/p>\n

Conclusions and Relevance<\/span> — We documented socioeconomic inequality in access to dabigatran among patients receiving warfarin for NVAF. This disparity was eliminated following the drug’s addition to the provincial formulary, highlighting the importance of timely reimbursement decisions.<\/p>\n","protected":false},"excerpt":{"rendered":"

Importance — Without third-party insurance, access to marketed drugs is limited to those who can afford to pay. We examined this phenomenon in the context of anticoagulation for patients with nonvalvular atrial fibrillation (NVAF). Objective — To determine whether, among older Ontarians receiving anticoagulation for NVAF, patients of higher socioeconomic status (SES) were more likely […]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[40,19,56],"migration-helper-qa-sample-set":[],"class_list":["post-6461","journal_article","type-journal_article","status-publish","hentry","topic-cardiovascular-disease","topic-marginalized-populations","topic-pharmacoepidemiology-and-drug-safety"],"acf":{"citation":"Sholzberg M, Gomes T, Juurlink DN, Yao Z, Mamdani MM, Laupacis A. PLoS One<\/em>. 2016; 11(2):e0149142.","source_url":"http:\/\/dx.plos.org\/10.1371\/journal.pone.0149142","ices_scientist":[1293,1252,1282,1325],"site":[6733,6735],"research_program":[6742,6746],"news_release":[7674],"journal_article":[],"atlas":[],"research_report":[],"infographic":[9298],"video":[],"downloads":null,"links":null,"sitecore_item_id":"27CD1231-654F-4E36-B539-6EADD5532878","sitecore_item_name":"The-influence-of-socioeconomic-status-on-selection-of-anticoagulation-for-atrial-fibrillation","sitecore_field_values":"{\n \"Content\": null,\n \"Title\": \"The influence of socioeconomic status on selection of anticoagulation for atrial fibrillation\",\n \"Summary\": \"The researchers examined the phenomenon that without third-party insurance, access to marketed drugs is limited to those who can afford to pay.\",\n \"Citation\": \"

Sholzberg M, Gomes T, Juurlink DN, Yao Z, Mamdani MM, Laupacis A. PLoS One<\/em>. 2016; 11(2):e0149142.<\/p>\",\n \"Abstract\": \"

Importance<\/strong> — Without third-party insurance, access to marketed drugs is limited to those who can afford to pay. We examined this phenomenon in the context of anticoagulation for patients with nonvalvular atrial fibrillation (NVAF).<\/p>rn

Objective<\/strong> — To determine whether, among older Ontarians receiving anticoagulation for NVAF, patients of higher socioeconomic status (SES) were more likely to switch from warfarin to dabigatran prior to its addition to the provincial formulary.<\/p>rn

Design, Setting and Participants<\/span> — Population-based retrospective cohort study of Ontarians aged 66 years and older, between 2008 and 2012.<\/p>rn

Exposure<\/strong> — Socioeconomic status, as approximated by median neighborhood income.<\/p>rn

Main Outcomes and Measure<\/span> — We identified two groups of older adults with nonvalvular atrial fibrillation: those who appeared to switch from warfarin to dabigatran after its market approval but prior to its inclusion on the provincial formulary (“switchers”), and those with ongoing warfarin use during the same interval (“non-switchers”).<\/p>rn

Results<\/strong> — We studied 34,797 patients, including 3183 “switchers” and 31,614 “non-switchers”. We found that higher SES was associated with switching to dabigatran prior to its coverage on the provincial formulary (p<0.0001). In multivariable analysis, subjects in the highest quintile were 50% more likely to switch to dabigatran than those in the lowest income quintile (11.3% vs. 7.3%; adjusted odds ratio 1.50; 95% CI 1.32 to 1.68). Following dabigatran’s addition to the formulary, the income gradient disappeared.<\/p>rn

Conclusions and Relevance<\/span> — We documented socioeconomic inequality in access to dabigatran among patients receiving warfarin for NVAF. This disparity was eliminated following the drug’s addition to the provincial formulary, highlighting the importance of timely reimbursement decisions.<\/p>rn

View full text<\/a><\/p>\",\n \"Keywords\": \"{263A4422-83C0-4DA7-9594-07606A469124}|{8DA96C16-E06B-4D90-802D-73D8A7C9612E}|{3B67F4BE-E30A-434A-8669-AE2A085C94E0}|{D4620196-76F6-4AE4-9103-FB996B44FAC4}\",\n \"Related Products\": \"

NEWS RELEASE<\/h2>rn

Lower income Ontario seniors less likely to access newly approved drugs: Ontario study <\/a><\/h3>rn

Infographic<\/h2>rn

Lower income Ontario seniors less likely to access newly approved drugs<\/a><\/h3>\",\n \"Research Programs\": \"{BEC72DE0-BA8C-42B8-ACE5-EE29FFB2CB3B}|{CFE36C89-C969-4C23-B5E4-1BA9E5BDC273}\",\n \"ICES Locations\": \"{4FCAABBA-14A5-42E6-8F33-BC6C2F1D9908}|{FBE2D1B1-C0BA-423F-8D16-39466B6C1424}\",\n \"ICES Scientists\": \"{83920C20-06BE-4C6B-9FA7-06B69A509A24}|{1FA4634A-81DF-4A25-8739-98ABF3872B45}|{5268F1B0-EB3E-4577-93DF-3C70C9399847}|{F2F916BC-2EE9-4C65-BCAB-086ED6BB971A}\",\n \"Posted Date\": \"20160225T000000\",\n \"Show on Publications Landing Page\": \"1\"\n}","previous_url":"https:\/\/www.ices.on.ca\/Publications\/Journal-Articles\/2016\/January\/The-influence-of-socioeconomic-status-on-selection-of-anticoagulation-for-atrial-fibrillation"},"yoast_head":"\nICES | The influence of socioeconomic status on selection of anticoagulation for atrial fibrillation<\/title>\n<meta name=\"description\" content=\"Importance — Without third-party insurance, access to marketed drugs is limited to those who can afford to pay. 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