{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T15:11:13Z","timestamp":1789053073766,"version":"build-2803163510"},"reference-count":40,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n While direct oral anticoagulants (DOACs) are recommended for treatment of patients with nonvalvular atrial fibrillation (NVAF) to reduce risk of mortality and stroke, studies have documented racial and ethnic disparities in DOAC use.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the associations between patient-physician race, ethnicity, and language concordance and DOAC treatment initiation and persistence.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n \n This retrospective cohort study was conducted using Kaiser Permanente Southern California electronic health records from January 1, 2012, through December 31, 2022. Adults 18 years of age or older with a confirmed diagnosis of NVAF and a CHA\n 2<\/jats:sub>\n DS\n 2<\/jats:sub>\n -VASc (congestive heart failure; hypertension; age \u226575 years; diabetes; prior stroke, transient ischemic attack, or thromboembolism; vascular disease; age 65-74 years; and sex category) score of 2 or higher were followed up from their first NVAF diagnosis to 60 days for a DOAC prescription order or from the first DOAC prescription fill to 1 year. Analysis was performed between April 2024 and January 2026.\n <\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Patient-physician race, ethnicity, and language concordance.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Associations of patient-physician race, ethnicity, and language concordance with DOAC therapy initiation (defined as the receipt of a DOAC prescription within 60 days from an initial NVAF diagnosis) and persistence (defined as 1 year of continuous DOAC prescription fills without a gap of 60 or more days) were determined using multivariable logistic regression models, accounting for age, sex, patient race and ethnicity, health insurance type, and neighborhood deprivation index.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of 59\u202f340 DOAC therapy\u2013eligible patients (mean [SD] age, 76.9 [9.1] years; 32\u202f889 [55.4%] females; 12\u202f440 [21.0%] Hispanic, 4803 [8.1%] non-Hispanic Asian, 5374 [9.1%] non-Hispanic Black, and 35\u202f645 [60.1%] non-Hispanic White), 34\u202f281 (57.8%) had a DOAC prescription order. Patient-physician race and ethnicity concordance was associated with increased odds of DOAC therapy initiation (odds ratio [OR], 1.19 [95% CI, 1.14-1.24]). Among 34\u202f215 patients with a DOAC prescription fill, 45.3% were persistent with DOAC therapy for 1 year. Both patient-physician race and ethnicity (OR, 1.08 [95% CI, 1.03-1.14]) and language (OR, 1.14 [95% CI, 1.04-1.24]) concordance were associated with increased odds of DOAC therapy persistence. Among Hispanic patients, patient-physician race and ethnicity concordance (OR, 1.39 [95% CI, 1.22-1.58]) was associated with increased odds of DOAC therapy initiation, and language concordance (OR, 1.12 [95% CI, 1.01-1.24]) was associated with increased odds of DOAC therapy persistence. Neither patient-physician race and ethnicity (OR, 1.04 [95% CI, 0.78-1.39] for initiation; OR, 1.03 [95% CI, 0.72-1.47] for persistence) nor language (OR, 0.61 [95% CI, 0.24-1.55] for initiation; OR, 1.62 [95% CI, 0.53-4.93] for persistence) concordance was associated with DOAC therapy initiation or persistence among non-Hispanic Black patients.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study, patient-physician race and ethnicity concordance was associated with increased odds of DOAC therapy initiation, whereas race, ethnicity, and language concordance were associated with increased odds of DOAC therapy persistence. These findings suggest patient-physician concordance as a potential pathway to support more equitable anticoagulation care.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.29363","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T15:00:37Z","timestamp":1789052437000},"page":"e2629363","source":"Crossref","is-referenced-by-count":0,"title":["Race, Ethnicity, and Language Concordance Between Patients and Physicians and Atrial Fibrillation DOAC Treatment"],"prefix":"10.1001","volume":"9","author":[{"given":"Michael","family":"Au","sequence":"first","affiliation":[{"name":"Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matt M.","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Sum","family":"Lee","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California"},{"name":"Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaejin","family":"An","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California"},{"name":"Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California"},{"name":"Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"zoi260804r1","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1016\/j.ahj.2016.05.014","article-title":"Defining nonvalvular atrial fibrillation: a quest for clarification.","volume":"178","author":"Martins","year":"2016","journal-title":"Am Heart J"},{"issue":"10","key":"zoi260804r2","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1212\/WNL.28.10.973","article-title":"Epidemiologic assessment of chronic atrial fibrillation and risk of stroke: the Framingham study.","volume":"28","author":"Wolf","year":"1978","journal-title":"Neurology"},{"issue":"8","key":"zoi260804r3","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.29333","article-title":"Risk levels and adverse clinical outcomes among patients with nonvalvular atrial fibrillation receiving oral anticoagulants.","volume":"5","author":"Lip","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"5","key":"zoi260804r4","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1016\/j.jacc.2020.09.011","article-title":"2020 ACC expert consensus decision pathway for anticoagulant and antiplatelet therapy in patients with atrial fibrillation or venous thromboembolism undergoing percutaneous coronary intervention or with atherosclerotic cardiovascular disease: a report of the American College of Cardiology Solution Set Oversight Committee.","volume":"77","author":"Kumbhani","year":"2021","journal-title":"J Am Coll Cardiol"},{"issue":"1","key":"zoi260804r5","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1161\/CIR.0000000000001193","article-title":"2023 ACC\/AHA\/ACCP\/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines.","volume":"149","author":"Joglar","year":"2024","journal-title":"Circulation"},{"issue":"5","key":"zoi260804r6","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.9465","article-title":"Racial and ethnic disparities in initiation of direct oral anticoagulants among Medicare beneficiaries.","volume":"7","author":"Reynolds","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"7","key":"zoi260804r7","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.14234","article-title":"Disparities in anticoagulant therapy initiation for incident atrial fibrillation by race\/ethnicity among patients in the Veterans Health Administration system.","volume":"4","author":"Essien","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"2","key":"zoi260804r8","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.121.008389","article-title":"Association of race and ethnicity and anticoagulation in patients with atrial fibrillation dually enrolled in Veterans Health Administration and Medicare: effects of Medicare Part D on prescribing disparities.","volume":"15","author":"Essien","year":"2022","journal-title":"Circ Cardiovasc Qual Outcomes"},{"issue":"12","key":"zoi260804r9","doi-asserted-by":"publisher","first-page":"1174","DOI":"10.1001\/jamacardio.2018.3945","article-title":"Association of race\/ethnicity with oral anticoagulant use in patients with atrial fibrillation: findings from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II.","volume":"3","author":"Essien","year":"2018","journal-title":"JAMA Cardiol"},{"issue":"21","key":"zoi260804r10","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.021601","article-title":"Long-term medication adherence trajectories to direct oral anticoagulants and clinical outcomes in patients with atrial fibrillation.","volume":"10","author":"An","year":"2021","journal-title":"J Am Heart Assoc"},{"issue":"3","key":"zoi260804r11","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1136\/heartjnl-2022-321377","article-title":"Trends in direct oral anticoagulant (DOAC) prescribing in English primary care (2014-2019).","volume":"109","author":"Joy","year":"2023","journal-title":"Heart"},{"issue":"4","key":"zoi260804r12","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1001\/jamacardio.2016.1025","article-title":"Racial differences in atrial fibrillation-related cardiovascular disease and mortality: the Atherosclerosis Risk in Communities (ARIC) study.","volume":"1","author":"Magnani","year":"2016","journal-title":"JAMA Cardiol"},{"issue":"7","key":"zoi260804r13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacadv.2025.101860","article-title":"Association of race and ethnicity with stroke and mortality outcomes in atrial fibrillation.","volume":"4","author":"Essien","year":"2025","journal-title":"JACC Adv"},{"issue":"3","key":"zoi260804r14","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1016\/j.jnma.2023.02.008","article-title":"Race, ethnicity, sex, and socioeconomic disparities in anticoagulation for atrial fibrillation: a narrative review of contemporary literature.","volume":"115","author":"Daly","year":"2023","journal-title":"J Natl Med Assoc"},{"issue":"11","key":"zoi260804r15","doi-asserted-by":"publisher","first-page":"1172","DOI":"10.1007\/s11606-010-1424-8","article-title":"Adherence to cardiovascular disease medications: does patient-provider race\/ethnicity and language concordance matter?","volume":"25","author":"Traylor","year":"2010","journal-title":"J Gen Intern Med"},{"issue":"3","key":"zoi260804r16","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1001\/jamainternmed.2016.8648","article-title":"Association of patient-physician language concordance and glycemic control for limited-English proficiency Latinos with type 2 diabetes.","volume":"177","author":"Parker","year":"2017","journal-title":"JAMA Intern Med"},{"key":"zoi260804r17","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2021.629041","article-title":"Physician-patient language discordance and poor health outcomes: a systematic scoping review.","volume":"9","author":"Cano-Ib\u00e1\u00f1ez","year":"2021","journal-title":"Front Public Health"},{"issue":"1","key":"zoi260804r18","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.70040","article-title":"Racial disparities in medication adherence and the patient-provider relationship: does racial\/ethnic concordance matter?","volume":"61","author":"Ma","year":"2026","journal-title":"Health Serv Res"},{"key":"zoi260804r19","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1016\/j.ahj.2018.03.003","article-title":"Predictors of oral anticoagulant non-prescription in patients with atrial fibrillation and elevated stroke risk.","volume":"200","author":"Lubitz","year":"2018","journal-title":"Am Heart J"},{"issue":"8","key":"zoi260804r20","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1002\/clc.24077","article-title":"Factors associated with oral anticoagulant prescription status among patients with a new diagnosis of atrial fibrillation.","volume":"46","author":"Manning","year":"2023","journal-title":"Clin Cardiol"},{"issue":"2","key":"zoi260804r21","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1378\/chest.09-1584","article-title":"Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on Atrial Fibrillation.","volume":"137","author":"Lip","year":"2010","journal-title":"Chest"},{"issue":"5","key":"zoi260804r22","doi-asserted-by":"publisher","DOI":"10.1111\/eci.13457","article-title":"Factors influencing oral anticoagulant use in patients newly diagnosed with atrial fibrillation.","volume":"51","author":"Bezabhe","year":"2021","journal-title":"Eur J Clin Invest"},{"issue":"11","key":"zoi260804r23","doi-asserted-by":"publisher","first-page":"1241","DOI":"10.1007\/s40273-024-01419-2","article-title":"Delay and pay? healthcare costs associated with late oral anti-coagulant prescribing in people with atrial fibrillation.","volume":"42","author":"Mulholland","year":"2024","journal-title":"Pharmacoeconomics"},{"issue":"6","key":"zoi260804r24","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0157769","article-title":"Treatment persistence and discontinuation with rivaroxaban, dabigatran, and warfarin for stroke prevention in patients with non-valvular atrial fibrillation in the United States.","volume":"11","author":"Coleman","year":"2016","journal-title":"PLoS One"},{"issue":"3","key":"zoi260804r25","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.119.005969","article-title":"Real-world adherence and persistence to direct oral anticoagulants in patients with atrial fibrillation: a systematic review and meta-analysis.","volume":"13","author":"Ozaki","year":"2020","journal-title":"Circ Cardiovasc Qual Outcomes"},{"issue":"6","key":"zoi260804r26","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1080\/03007995.2021.1897555","article-title":"Real-world persistence to direct oral anticoagulants in patients with atrial fibrillation: a systematic review and network meta-analysis.","volume":"37","author":"Deitelzweig","year":"2021","journal-title":"Curr Med Res Opin"},{"issue":"23-24","key":"zoi260804r27","doi-asserted-by":"publisher","first-page":"4325","DOI":"10.1111\/jocn.13759","article-title":"Barriers and enablers to adherence to anticoagulation in heart failure with atrial fibrillation: patient and provider perspectives.","volume":"26","author":"Ferguson","year":"2017","journal-title":"J Clin Nurs"},{"issue":"11","key":"zoi260804r28","doi-asserted-by":"publisher","first-page":"1982","DOI":"10.1016\/j.pec.2018.06.019","article-title":"Perceived advantages and disadvantages of oral anticoagulants, and the trade-offs patients make in choosing anticoagulant therapy and adhering to their drug regimen.","volume":"101","author":"Vaanholt","year":"2018","journal-title":"Patient Educ Couns"},{"issue":"1","key":"zoi260804r29","doi-asserted-by":"publisher","first-page":"1084","DOI":"10.1186\/s12913-020-05947-3","article-title":"Understanding the barriers to using oral anticoagulants among long-term aspirin users with atrial fibrillation - a qualitative study.","volume":"20","author":"Ng","year":"2020","journal-title":"BMC Health Serv Res"},{"issue":"5","key":"zoi260804r30","doi-asserted-by":"publisher","first-page":"478","DOI":"10.3122\/jabfm.19.5.478","article-title":"Primary medication adherence in a rural population: the role of the patient-physician relationship and satisfaction with care.","volume":"19","author":"Wroth","year":"2006","journal-title":"J Am Board Fam Med"},{"issue":"5","key":"zoi260804r31","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1016\/j.jval.2013.04.014","article-title":"A systematic literature review of psychosocial and behavioral factors associated with initial medication adherence: a report of the ISPOR medication adherence & persistence special interest group.","volume":"16","author":"Zeber","year":"2013","journal-title":"Value Health"},{"issue":"8","key":"zoi260804r32","doi-asserted-by":"publisher","first-page":"1591","DOI":"10.1007\/s11606-019-04847-5","article-title":"A systematic review of the impact of patient-physician non-English language concordance on quality of care and outcomes.","volume":"34","author":"Diamond","year":"2019","journal-title":"J Gen Intern Med"},{"issue":"10","key":"zoi260804r33","doi-asserted-by":"publisher","first-page":"1883","DOI":"10.1016\/j.pec.2020.05.025","article-title":"Scoping review: definitions and outcomes of patient-provider language concordance in healthcare.","volume":"103","author":"Lor","year":"2020","journal-title":"Patient Educ Couns"},{"issue":"12","key":"zoi260804r34","doi-asserted-by":"publisher","first-page":"2161","DOI":"10.2105\/AJPH.2005.068668","article-title":"Latino populations: a unique opportunity for the study of race, genetics, and social environment in epidemiological research.","volume":"95","author":"Gonz\u00e1lez Burchard","year":"2005","journal-title":"Am J Public Health"},{"key":"zoi260804r35","doi-asserted-by":"publisher","first-page":"8954","DOI":"10.1073\/pnas.0914618107","article-title":"Colloquium paper: genome-wide patterns of population structure and admixture among Hispanic\/Latino populations.","volume":"107","author":"Bryc","year":"2010","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"1","key":"zoi260804r36","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1016\/j.ajhg.2015.12.001","article-title":"Genetic diversity and association studies in US Hispanic\/Latino populations: applications in the Hispanic Community Health Study\/Study of Latinos.","volume":"98","author":"Conomos","year":"2016","journal-title":"Am J Hum Genet"},{"issue":"3","key":"zoi260804r37","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1370\/afm.3103","article-title":"We are not all the same: implications of heterogeneity among Latin\u00e9\/e\/x\/o\/a, Hispanic, and Spanish origin people.","volume":"22","author":"Carvajal","year":"2024","journal-title":"Ann Fam Med"},{"issue":"1","key":"zoi260804r38","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1370\/afm.2632","article-title":"Discrimination and medical mistrust in a racially and ethnically diverse sample of California adults.","volume":"19","author":"Bazargan","year":"2021","journal-title":"Ann Fam Med"},{"issue":"14","key":"zoi260804r39","doi-asserted-by":"publisher","first-page":"2747","DOI":"10.1007\/s11606-024-08997-z","article-title":"Medical mistrust among black patients with serious illness: a mixed methods study.","volume":"39","author":"Cueva","year":"2024","journal-title":"J Gen Intern Med"},{"issue":"11","key":"zoi260804r40","doi-asserted-by":"publisher","first-page":"2548","DOI":"10.1007\/s11606-025-09627-y","article-title":"Racial and ethnic disparities in perceived healthcare discrimination and health outcomes.","volume":"40","author":"Sabater Minarim","year":"2025","journal-title":"J Gen Intern Med"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2853884\/au_2026_oi_260804_1788358382.40906.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T15:00:38Z","timestamp":1789052438000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2853884"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,10]]},"references-count":40,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.29363","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,10]]}}}