The Influence of Socioeconomic Status on Selection of Anticoagulation for Atrial Fibrillation
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{"title"=>"The influence of socioeconomic status on selection of anticoagulation for atrial fibrillation", "type"=>"journal", "authors"=>[{"first_name"=>"Michelle", "last_name"=>"Sholzberg", "scopus_author_id"=>"54986195200"}, {"first_name"=>"Tara", "last_name"=>"Gomes", "scopus_author_id"=>"23088240100"}, {"first_name"=>"David N.", "last_name"=>"Juurlink", "scopus_author_id"=>"7006139615"}, {"first_name"=>"Zhan", "last_name"=>"Yao", "scopus_author_id"=>"54391870100"}, {"first_name"=>"Muhammad M.", "last_name"=>"Mamdani", "scopus_author_id"=>"7007185828"}, {"first_name"=>"Andreas", "last_name"=>"Laupacis", "scopus_author_id"=>"7101605905"}], "year"=>2016, "source"=>"PLoS ONE", "identifiers"=>{"issn"=>"19326203", "doi"=>"10.1371/journal.pone.0149142", "sgr"=>"84979022027", "scopus"=>"2-s2.0-84979022027", "pmid"=>"26914450", "pui"=>"611090362"}, "id"=>"e5ac2dc1-2c8d-3f3b-8978-a06d6ab9604b", "abstract"=>"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 to switch from warfarin to dabigatran prior to its addition to the provincial formulary. DESIGN, SETTING AND PARTICIPANTS Population-based retrospective cohort study of Ontarians aged 66 years and older, between 2008 and 2012. EXPOSURE Socioeconomic status, as approximated by median neighborhood income. MAIN OUTCOMES AND MEASURE 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\"). RESULTS 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. CONCLUSIONS AND RELEVANCE 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.", "link"=>"http://www.mendeley.com/research/influence-socioeconomic-status-selection-anticoagulation-atrial-fibrillation-1", "reader_count"=>20, "reader_count_by_academic_status"=>{"Unspecified"=>1, "Professor > Associate Professor"=>1, "Researcher"=>1, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>1, "Student > Postgraduate"=>2, "Student > Master"=>8, "Other"=>1, "Student > Bachelor"=>3, "Professor"=>1}, "reader_count_by_user_role"=>{"Unspecified"=>1, "Professor > Associate Professor"=>1, "Researcher"=>1, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>1, "Student > Postgraduate"=>2, "Student > Master"=>8, "Other"=>1, "Student > Bachelor"=>3, "Professor"=>1}, "reader_count_by_subject_area"=>{"Unspecified"=>3, "Medicine and Dentistry"=>14, "Pharmacology, Toxicology and Pharmaceutical Science"=>3}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>14}, "Unspecified"=>{"Unspecified"=>3}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>3}}, "reader_count_by_country"=>{"Canada"=>1, "Slovenia"=>1}, "group_count"=>0}

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/4740646"], "description"=>"<p>Primary Analysis: Odds of Switching to Dabigatran Prior to ODBP listing of Dabigatran–Adjusted Model.</p>", "links"=>[], "tags"=>["2012. ExposureSocioeconomic status", "multivariable analysis", "market approval", "NVAF", "warfarin use", "Socioeconomic Status", "nonvalvular atrial fibrillation", "66 years", "dabigatran", "SES", "reimbursement decisions", "income gradient disappeared.Conclusions", "CI", "neighborhood income.Main Outcomes", "formulary", "Atrial Fibrillation ImportanceWithout"], "article_id"=>3037477, "categories"=>["Medicine", "Cell Biology", "Genetics", "Molecular Biology", "Pharmacology", "Biotechnology", "Developmental Biology", "Marine Biology", "Cancer", "Infectious Diseases", "Virology", "Computational Biology"], "users"=>["Michelle Sholzberg", "Tara Gomes", "David N. Juurlink", "Zhan Yao", "Muhammad M. Mamdani", "Andreas Laupacis"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0149142.t001", "stats"=>{"downloads"=>0, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Primary_Analysis_Odds_of_Switching_to_Dabigatran_Prior_to_ODBP_listing_of_Dabigatran_Adjusted_Model_/3037477", "title"=>"Primary Analysis: Odds of Switching to Dabigatran Prior to ODBP listing of Dabigatran–Adjusted Model.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2016-02-25 11:33:50"}
  • {"files"=>["https://ndownloader.figshare.com/files/4740601"], "description"=>"<p><u>Legend:</u><sup>1</sup> Patient with Non-Valvular Atrial Fibrillation on warfarin over the age of 66 years.<sup>2</sup> Non-switchers are those with ≥ 2 warfarin prescriptions in the 6 months prior to dabigatran being listed on the public formulary. <sup>3</sup> Switchers are those with NO warfarin prescriptions in the 6 months prior to dabigatran being listed on the public formulary.</p>", "links"=>[], "tags"=>["2012. ExposureSocioeconomic status", "multivariable analysis", "market approval", "NVAF", "warfarin use", "Socioeconomic Status", "nonvalvular atrial fibrillation", "66 years", "dabigatran", "SES", "reimbursement decisions", "income gradient disappeared.Conclusions", "CI", "neighborhood income.Main Outcomes", "formulary", "Atrial Fibrillation ImportanceWithout"], "article_id"=>3037447, "categories"=>["Medicine", "Cell Biology", "Genetics", "Molecular Biology", "Pharmacology", "Biotechnology", "Developmental Biology", "Marine Biology", "Cancer", "Infectious Diseases", "Virology", "Computational Biology"], "users"=>["Michelle Sholzberg", "Tara Gomes", "David N. Juurlink", "Zhan Yao", "Muhammad M. Mamdani", "Andreas Laupacis"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0149142.g001", "stats"=>{"downloads"=>2, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Study_Design_/3037447", "title"=>"Study Design.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2016-02-25 11:33:50"}
  • {"files"=>["https://ndownloader.figshare.com/files/4740502", "https://ndownloader.figshare.com/files/4740511", "https://ndownloader.figshare.com/files/4740526", "https://ndownloader.figshare.com/files/4740541", "https://ndownloader.figshare.com/files/4740550"], "description"=>"<div><p>Importance</p><p>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><p>Objective</p><p>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><p>Design, Setting and Participants</p><p>Population-based retrospective cohort study of Ontarians aged 66 years and older, between 2008 and 2012.</p><p>Exposure</p><p>Socioeconomic status, as approximated by median neighborhood income.</p><p>Main Outcomes and Measure</p><p>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><p>Results</p><p>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><p>Conclusions and Relevance</p><p>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></div>", "links"=>[], "tags"=>["2012. ExposureSocioeconomic status", "multivariable analysis", "market approval", "NVAF", "warfarin use", "Socioeconomic Status", "nonvalvular atrial fibrillation", "66 years", "dabigatran", "SES", "reimbursement decisions", "income gradient disappeared.Conclusions", "CI", "neighborhood income.Main Outcomes", "formulary", "Atrial Fibrillation ImportanceWithout"], "article_id"=>3037384, "categories"=>["Medicine", "Cell Biology", "Genetics", "Molecular Biology", "Pharmacology", "Biotechnology", "Developmental Biology", "Marine Biology", "Cancer", "Infectious Diseases", "Virology", "Computational Biology"], "users"=>["Michelle Sholzberg", "Tara Gomes", "David N. Juurlink", "Zhan Yao", "Muhammad M. Mamdani", "Andreas Laupacis"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0149142.s001", "https://dx.doi.org/10.1371/journal.pone.0149142.s002", "https://dx.doi.org/10.1371/journal.pone.0149142.s003", "https://dx.doi.org/10.1371/journal.pone.0149142.s004", "https://dx.doi.org/10.1371/journal.pone.0149142.s005"], "stats"=>{"downloads"=>1, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/The_Influence_of_Socioeconomic_Status_on_Selection_of_Anticoagulation_for_Atrial_Fibrillation/3037384", "title"=>"The Influence of Socioeconomic Status on Selection of Anticoagulation for Atrial Fibrillation", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2016-02-25 11:33:50"}
  • {"files"=>["https://ndownloader.figshare.com/files/4740814"], "description"=>"<p>Assessment for Trend of Switchers across Income Quintiles Prior to ODBP listing of Dabigatran.</p>", "links"=>[], "tags"=>["2012. ExposureSocioeconomic status", "multivariable analysis", "market approval", "NVAF", "warfarin use", "Socioeconomic Status", "nonvalvular atrial fibrillation", "66 years", "dabigatran", "SES", "reimbursement decisions", "income gradient disappeared.Conclusions", "CI", "neighborhood income.Main Outcomes", "formulary", "Atrial Fibrillation ImportanceWithout"], "article_id"=>3037591, "categories"=>["Medicine", "Cell Biology", "Genetics", "Molecular Biology", "Pharmacology", "Biotechnology", "Developmental Biology", "Marine Biology", "Cancer", "Infectious Diseases", "Virology", "Computational Biology"], "users"=>["Michelle Sholzberg", "Tara Gomes", "David N. Juurlink", "Zhan Yao", "Muhammad M. Mamdani", "Andreas Laupacis"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0149142.t004", "stats"=>{"downloads"=>1, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Assessment_for_Trend_of_Switchers_across_Income_Quintiles_Prior_to_ODBP_listing_of_Dabigatran_/3037591", "title"=>"Assessment for Trend of Switchers across Income Quintiles Prior to ODBP listing of Dabigatran.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2016-02-25 11:33:50"}
  • {"files"=>["https://ndownloader.figshare.com/files/4740694"], "description"=>"<p>Secondary Analysis: Odds of Switching to Dabigatran after ODBP listing of Dabigatran–Adjusted Model.</p>", "links"=>[], "tags"=>["2012. ExposureSocioeconomic status", "multivariable analysis", "market approval", "NVAF", "warfarin use", "Socioeconomic Status", "nonvalvular atrial fibrillation", "66 years", "dabigatran", "SES", "reimbursement decisions", "income gradient disappeared.Conclusions", "CI", "neighborhood income.Main Outcomes", "formulary", "Atrial Fibrillation ImportanceWithout"], "article_id"=>3037516, "categories"=>["Medicine", "Cell Biology", "Genetics", "Molecular Biology", "Pharmacology", "Biotechnology", "Developmental Biology", "Marine Biology", "Cancer", "Infectious Diseases", "Virology", "Computational Biology"], "users"=>["Michelle Sholzberg", "Tara Gomes", "David N. Juurlink", "Zhan Yao", "Muhammad M. Mamdani", "Andreas Laupacis"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0149142.t002", "stats"=>{"downloads"=>0, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Secondary_Analysis_Odds_of_Switching_to_Dabigatran_after_ODBP_listing_of_Dabigatran_Adjusted_Model_/3037516", "title"=>"Secondary Analysis: Odds of Switching to Dabigatran after ODBP listing of Dabigatran–Adjusted Model.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2016-02-25 11:33:50"}
  • {"files"=>["https://ndownloader.figshare.com/files/4740745"], "description"=>"<p>Baseline Characteristics of Elderly Ontarians with Non-Valvular Atrial Fibrillation.</p>", "links"=>[], "tags"=>["2012. ExposureSocioeconomic status", "multivariable analysis", "market approval", "NVAF", "warfarin use", "Socioeconomic Status", "nonvalvular atrial fibrillation", "66 years", "dabigatran", "SES", "reimbursement decisions", "income gradient disappeared.Conclusions", "CI", "neighborhood income.Main Outcomes", "formulary", "Atrial Fibrillation ImportanceWithout"], "article_id"=>3037549, "categories"=>["Medicine", "Cell Biology", "Genetics", "Molecular Biology", "Pharmacology", "Biotechnology", "Developmental Biology", "Marine Biology", "Cancer", "Infectious Diseases", "Virology", "Computational Biology"], "users"=>["Michelle Sholzberg", "Tara Gomes", "David N. Juurlink", "Zhan Yao", "Muhammad M. Mamdani", "Andreas Laupacis"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0149142.t003", "stats"=>{"downloads"=>0, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Baseline_Characteristics_of_Elderly_Ontarians_with_Non_Valvular_Atrial_Fibrillation_/3037549", "title"=>"Baseline Characteristics of Elderly Ontarians with Non-Valvular Atrial Fibrillation.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2016-02-25 11:33:50"}

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Relative Metric

{"start_date"=>"2016-01-01T00:00:00Z", "end_date"=>"2016-12-31T00:00:00Z", "subject_areas"=>[]}
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