Race- and Neighborhood-Level Social Determinants of Health in Diagnosis and Treatment of Atrial Fibrillation
4 affiliations
- 1Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- 2Independence Blue Cross, Philadelphia, Pennsylvania
- 3Now with Merck Sharp and Dohme LLC, Merck and Co, Inc, Rahway, New Jersey
- 4Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
Abstract
Importance: Early diagnosis and treatment of atrial fibrillation (AF) is critical for preventing stroke, heart failure, and mortality. Understanding patterns in diagnosis and treatment of AF may improve detection and reduce disparities.
Objective: To evaluate the interactions between race and ethnicity and neighborhood social determinants of health on AF diagnosis and treatment.
Design, Setting, and Participants: Retrospective cohort study using administrative claims for greater Philadelphia, Pennsylvania, area residents aged 18 years or older from Independence Blue Cross from 2017 to 2021. Baseline characteristics were assessed in 2017, and participants were followed up from 2018 through 2021. Data were analyzed from October 2023 to July 2026.
Exposures: Exposures included Non-Hispanic Black race and ethnicity, neighborhood-level social determinants of health as measured by the social barrier index (SBI), and the interaction between the two.
Main Outcomes and Measures: The primary outcome was AF diagnosis ascertained from International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes. The secondary outcome was anticoagulant prescription among individuals with AF diagnoses as ascertained from pharmacy claims.
Results: Of the 504 876 patients included, the mean (SD) age was 48 (18) years; 267 596 (53.0%) were female; 67 362 (13.3%) non-Hispanic Black, and 437 514 (86.7%) were non-Hispanic White. A total of 27 249 patients (5.1%) were diagnosed with AF during the study period. Non-Hispanic Black patients were less likely to be diagnosed with AF compared with non-Hispanic White patients (odds ratio [OR], 0.91; 95% CI, 0.82-1.00). The relative difference increased with increased SBI (which denotes more vulnerable neighborhoods) as shown by a significant interaction between race and ethnicity and SBI (OR, 0.90; 95% CI, 0.86-0.95). Among those diagnosed with AF, 15 722 (58%) had an anticoagulant prescription. There was a significant interaction between race and ethnicity and SBI (OR, 1.10; 95% CI, 1.00-1.20), suggesting that filled prescription patterns differed by race and ethnicity with SBI. For Black individuals one unit increase in SBI was associated with decreased odds of AF diagnosis (OR, 0.94; 95% CI, 0.90-0.99). For White individuals one unit increase in SBI was associated with increased odds of AF diagnosis (OR, 1.05; 95% CI, 1.03-1.07).
Conclusions and Relevance: This cohort study of Medicare Advantage and commercially insured individuals found that AF diagnosis rates declined with worsening neighborhood-level disadvantage among non-Hispanic Black individuals but increased among non-Hispanic White individuals. Conditional on diagnoses, rates of prescription of anticoagulants were similar across race and ethnicity groups. Targeted interventions, especially in more marginalized neighborhoods, are needed to increase detection of AF.
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BibTeX
@article{amagai2026race,
title = {{Race- and Neighborhood-Level Social Determinants of Health in Diagnosis and Treatment of Atrial Fibrillation}},
author = {Kano Amagai and Alya Nadji and Melissa Berkowitz and Atheendar S. Venkataramani and Erica L. Dixon},
journal = {JAMA Network Open},
year = {2026},
month = oct,
doi = {10.1001/jamanetworkopen.2026.40279},
url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855777},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Race- and Neighborhood-Level Social Determinants of Health in Diagnosis and Treatment of Atrial Fibrillation
AU - Kano Amagai
AU - Alya Nadji
AU - Melissa Berkowitz
AU - Atheendar S. Venkataramani
AU - Erica L. Dixon
PY - 2026
DA - 2026/10/01
JO - JAMA Network Open
DO - 10.1001/jamanetworkopen.2026.40279
UR - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855777
AB - Importance: Early diagnosis and treatment of atrial fibrillation (AF) is critical for preventing stroke, heart failure, and mortality. Understanding patterns in diagnosis and treatment of AF may improve detection and reduce disparities. Objective: To evaluate the interactions between race and ethnicity and neighborhood social determinants of health on AF diagnosis and treatment. Design, Setting, and Participants: Retrospective cohort study using administrative claims for greater Philadelphia, Pennsylvania, area residents aged 18 years or older from Independence Blue Cross from 2017 to 2021. Baseline characteristics were assessed in 2017, and participants were followed up from 2018 through 2021. Data were analyzed from October 2023 to July 2026. Exposures: Exposures included Non-Hispanic Black race and ethnicity, neighborhood-level social determinants of health as measured by the social barrier index (SBI), and the interaction between the two. Main Outcomes and Measures: The primary outcome was AF diagnosis ascertained from International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes. The secondary outcome was anticoagulant prescription among individuals with AF diagnoses as ascertained from pharmacy claims. Results: Of the 504 876 patients included, the mean (SD) age was 48 (18) years; 267 596 (53.0%) were female; 67 362 (13.3%) non-Hispanic Black, and 437 514 (86.7%) were non-Hispanic White. A total of 27 249 patients (5.1%) were diagnosed with AF during the study period. Non-Hispanic Black patients were less likely to be diagnosed with AF compared with non-Hispanic White patients (odds ratio [OR], 0.91; 95% CI, 0.82-1.00). The relative difference increased with increased SBI (which denotes more vulnerable neighborhoods) as shown by a significant interaction between race and ethnicity and SBI (OR, 0.90; 95% CI, 0.86-0.95). Among those diagnosed with AF, 15 722 (58%) had an anticoagulant prescription. There was a significant interaction between race and ethnicity and SBI (OR, 1.10; 95% CI, 1.00-1.20), suggesting that filled prescription patterns differed by race and ethnicity with SBI. For Black individuals one unit increase in SBI was associated with decreased odds of AF diagnosis (OR, 0.94; 95% CI, 0.90-0.99). For White individuals one unit increase in SBI was associated with increased odds of AF diagnosis (OR, 1.05; 95% CI, 1.03-1.07). Conclusions and Relevance: This cohort study of Medicare Advantage and commercially insured individuals found that AF diagnosis rates declined with worsening neighborhood-level disadvantage among non-Hispanic Black individuals but increased among non-Hispanic White individuals. Conditional on diagnoses, rates of prescription of anticoagulants were similar across race and ethnicity groups. Targeted interventions, especially in more marginalized neighborhoods, are needed to increase detection of AF.
SN - 2574-3805
ER -