2872Association between sociodemographic factors and choice of Direct Oral Anticoagulants versus warfarin in atrial fibrillation: A population based cross-sectional study using Swedish Registers

Abstract

Background: The healthcare system in Sweden is publicly funded and aims to provide equal access to care irrespective of differences in socioeconomic status. This also includes ensuring equity in drug treatment. However, available information suggest that patients with low socioeconomic status are less likely to receive new drugs. Objective(s): To study the association between sociodemographic factors and choice of either a Direct Oral Anticoagulant (Rivaroxaban, Dabigatran, Apixaban) or warfarin in atrial fibrillation patients. Method(s): Cross-sectional study using Swedish administrative registers. All patients with a diagnosis of nonvalvular atrial fibrillation aged 18 years or older who filled their first prescription for a DOAC or warfarin between 01 December 2011 and 31 December 2014 were included. Patients previously exposed to an oral anticoagulant were excluded. Multivariable logistic regression was used to identify sociodemographic factors associated with the choice of anticoagulant treatment. Result(s): Overall 68,056 patients met the study criteria of which 27.4% (n=18,638) received a DOAC and 72.6% (n=49,418) received warfarin. Multivariable regression showed that highly educated patients (adjusted odds ratio [OR] = 1.37, 95% confidence interval [CI] 1.30-1.45) and patients in the highest income quartile (OR = 1.23, CI 1.16-1.31) were more likely to initiate a DOAC after adjustment for age, sex, family status, immigrant status, comorbidities and use of other drugs. Patients in the rural Norrland region were less likely to receive a DOAC than patients in urban areas (OR = 0.48, CI 0.45-0.51). Females had higher probability for DOAC initiation compared to males (OR 1.05, CI 1.01-1.10). Conclusion(s): High socioeconomic status and urban residence were associated with higher likelihood for receiving a DOAC than warfarin even in a health system that aims to ensure equality in drug treatment through subsidies. Even though other studies have indicated that women do not have access to new medicines to the same extent as men, our study indicated no discrimination of women regarding choice of anticoagulants. (Figure presented).