Quality of anticoagulation control: do race and language matter?
No studies have evaluated the quality of anticoagulation control among populations characterized by low socioeconomic status, diverse racial and ethnic backgrounds, or limited English proficiency. We conducted a retrospective cohort study to evaluate the effects of race/ethnicity and language on anticoagulation outcomes among patients (N=864) receiving continuous anticoagulation services at a university-affiliated public hospital. White/non-Hispanic patients made up 24%, Asian/Pacific Islanders 33%, Hispanics 22%, African Americans 18%. English (63%), Spanish, (14%), and Cantonese (13%) were the most common languages. Mean time in therapeutic range (TTR) was 43%. After adjustment, TTR was lower for African Americans than for Whites (absolute difference, -8.7%, p< .001) and for Spanish-speaking than for English-speaking Hispanics (absolute difference, -7.2%, p< .05). There were no differences between Asian/Pacific Islanders and Whites, nor between Cantonese-speaking and English-speaking Asian/Pacific Islanders. Future research should examine mechanisms by which race/ethnicity and language affect quality of anticoagulation and evaluate programs to improve treatment in diverse communities.
Bhandari
Vijay Kumar
VK
Department of Internal Medicine, University of California at San Francisco (UCSF), San Francisco, CA 94117, USA. Vijay.Bhandari@ucsf.edu
Wang
Frances
F
Bindman
Andrew B
AB
Schillinger
Dean
D
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy* / Q000208:ethnology*; D005006:Ethnicity; D005260:Female; D006785:Hospitals, University; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data; D019934:International Normalized Ratio; D007802:Language; D008297:Male; D008875:Middle Aged; D019338:Polypharmacy; D044469:Racial Groups; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000150:complications; D016896:Treatment Outcome
D000925:Anticoagulants