title: Explaining racial disparities in anticoagulation control: results from a study of patients at the Veterans Administration.
abstract: Higher rates of stroke, major hemorrhage, and death among black patients receiving warfarin, compared with white patients, is likely related to poorer anticoagulation control. The research team investigated patient-level and site-level factors that might account for this group difference. A summary measure of anticoagulation control (percent time in therapeutic range [TTR]), patient characteristics, and site-level process of care measures were obtained for 9572 black and 88 481 white patients at the Veterans Health Administration. The research team studied disparity in TTR adjusting for patient and site characteristics. Mean unadjusted TTR for black patients was 6.5% lower than for white patients (P<.001). After accounting for the younger age of blacks, greater degrees of medication use, hospitalization, poverty, living in the South, and 11 other patient characteristics, only 2.0% of this racial disparity persisted. Process of care measures had minimal additional effect. These findings may inform efforts to reduce this racial disparity in achieving good anticoagulation control.
authors.affiliation: Bedford VA Medical Center, Bedford, MA University of Massachusetts Medical School, Worcester, MA sowmya.rao@umassmed.edu.
authors.forename: Sowmya R
authors.initials: SR
authors.lastname: Rao
authors.affiliation: Bedford VA Medical Center, Bedford, MA.
authors.forename: Joel I
authors.initials: JI
authors.lastname: Reisman
authors.affiliation: VA Boston Healthcare System, Boston, MA Boston University School of Medicine, Boston, MA.
authors.forename: Nancy R
authors.initials: NR
authors.lastname: Kressin
authors.affiliation: Bedford VA Medical Center, Bedford, MA Boston University School of Medicine, Boston, MA Boston University School of Public Health, Boston, MA.
authors.forename: Dan R
authors.initials: DR
authors.lastname: Berlowitz
authors.affiliation: Bedford VA Medical Center, Bedford, MA University of Massachusetts Medical School, Worcester, MA.
authors.forename: Arlene S
authors.initials: AS
authors.lastname: Ash
authors.affiliation: Bedford VA Medical Center, Bedford, MA Boston Children's Hospital, Boston, MA.
authors.forename: Al
authors.initials: A
authors.lastname: Ozonoff
authors.affiliation: Bedford VA Medical Center, Bedford, MA Boston University School of Public Health, Boston, MA.
authors.forename: Donald R
authors.initials: DR
authors.lastname: Miller
authors.affiliation: Boston University School of Medicine, Boston, MA.
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Hylek
authors.affiliation: Bedford VA Medical Center, Bedford, MA.
authors.forename: Shibei
authors.initials: S
authors.lastname: Zhao
authors.affiliation: Bedford VA Medical Center, Bedford, MA Boston University School of Medicine, Boston, MA.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Rose
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy; D015897:Comorbidity; D005260:Female; D006304:Health Status; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019338:Polypharmacy; D017064:Process Assessment, Health Care; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D054556:Venous Thromboembolism / Q000188:drug therapy; D014859:Warfarin / Q000008:administration & dosage* / Q000627:therapeutic use; D044465:White People
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: anticoagulants; quality of health care; racial and ethnic disparities; warfarin