title: Quality of anticoagulation control: do race and language matter?
abstract: 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.
authors.affiliation: Department of Internal Medicine, University of California at San Francisco (UCSF), San Francisco, CA 94117, USA. Vijay.Bhandari@ucsf.edu
authors.forename: Vijay Kumar
authors.initials: VK
authors.lastname: Bhandari
authors.forename: Frances
authors.initials: F
authors.lastname: Wang
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Bindman
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
mesh_terms: 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
chemical_list: D000925:Anticoagulants