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The Association between Neighborhood Socioeconomic Status, Geographical Area and Non-persistence to Using DOACs

1LUMC, Department of Clinical Epidemiology, Leiden, the Netherlands, 2Amsterdam Medical Centers, Location AMC, Department of Hospital Pharmacy, Amsterdam, the Netherlands, 3LUMC, Department Clinical Pharmacy and Toxicology, Leiden, the Netherlands, 4LUMC, Department of Internal Medicine, Division of Thrombosis and Haemostasis, Leiden, the Netherlands

Abstract Number: PB2081

Meeting: ISTH 2020 Congress

Theme: Venous Thromboembolism and Cardioembolism » Atrial Fibrillation

Background: Previous studies have described suboptimal persistence to direct oral anticoagulant (DOAC) use for which the reasons are not well known.

Aims: To study whether urbanization, neighborhood socioeconomic status or regional policy of DOAC prescribing (identified by geographical area) is associated with DOAC non-persistence.

Methods: Dispensing data from the Dutch Foundation of Pharmaceutical Statistics were used to monitor non-persistence to DOAC in atrial fibrillation (AF) patients from January 2012-April 2016. AF patients who could be followed for at least 1 year were included. Non-persistence was defined as the cumulative incidence of patients who discontinued their DOAC within 1 year. The association between non-persistence and neighborhood socioeconomic status was evaluated by considering property value, status-score (which combines educational level, income and unemployment) and urbanization (all stratified by quintiles). In addition, we studied non-persistence to DOAC across geographic areas.

Results: 43670 AF patients were included (mean age 70 years), 20130 (46%) were men, 4951 (11%) used apixaban, 18387 (42%) dabigatran, and 20332 (47%) rivaroxaban. The overall non-persistence rate was 41% within 12 months. Non-persistence was not associated with urbanization, status-score or property value (first vs other quintiles, risk ratios ranged between 0.91-1.02). Geographical rates of non-persistence ranged between 17-73% (Figure 1). Of the lowest scoring regions (bottom five), all prescribed rivaroxaban most often, showing that non-persistence may be related to rivaroxaban use. However, in the highest scoring regions (top five) two also prescribed rivaroxaban most often, suggesting that non-persistence is also related with prescribing patterns (e.g., instructions, monitoring).

Conclusions: In the Netherlands, non-persistence to DOAC was not associated with urbanization, neighborhood socioeconomic status or neighborhood property value. However, DOAC non-persistence varied substantially across areas, suggesting that local policy, for example monitoring, may be relevant for DOAC persistence.


[Figure 1. Geographical distribution of non-persistence to DOAC in the Netherlands (red is highest)]

To cite this abstract in AMA style:

van Rein N, Zielinkski GD, Ras EM, Teichert M, Klok FA, Rosendaal FR, van der Meer FJM, Huisman MV, Cannegieter SC, Lijfering WM. The Association between Neighborhood Socioeconomic Status, Geographical Area and Non-persistence to Using DOACs [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/the-association-between-neighborhood-socioeconomic-status-geographical-area-and-non-persistence-to-using-doacs/. Accessed September 29, 2023.

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