{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T20:03:59Z","timestamp":1791576239539,"version":"4.3.4"},"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2024,12,12]],"date-time":"2024-12-12T00:00:00Z","timestamp":1733961600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Bristol Myers Squibb-Pfizer Alliance"},{"name":"Bristol Myers Squibb"},{"name":"Bristol Myers Squibb"},{"name":"Bristol Myers Squibb"},{"name":"Bristol Myers Squibb"},{"DOI":"10.13039\/100012416","name":"Inova Health System","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012416","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006510","name":"Duke University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006510","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004319","name":"Pfizer","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004319","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Use of oral anticoagulants (OACs) for stroke reduction in atrial fibrillation (AF) varies by race and geography within the United States. We seek to better understand the relationship between OAC underutilization, race, and US geography.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Patients with AF were selected from the US Centers for Medicare &amp; Medicaid Services claims database from January 1, 2013, to December 31, 2016. The final population consisted of patients with 12 months of health plan enrollment before and after their index AF diagnosis, with a baseline CHAD<jats:sub>2<\/jats:sub>S<jats:sub>2<\/jats:sub>-VASc \u22652 and of either Black or White race (other races are underrepresented in the data). Among those with AF that met the inclusion criteria, patients who were prescribed warfarin or DOACs within 12 months after the index date were extracted. Each patient was assigned to a US county based on their 5-digit zip code and OAC use was stratified by race. Statistically significant differences were determined by student\u2019s t-test and chi-square.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Of the 2,390,830 final patients, 94.1% were White and 5.9% were Black patients. Mean (SD) age and HASBLED scores were 78 (9) and 3.9 (1.2) respectively, for Black patients and 80 (9) and 3.3 (1.2), respectively, for White patients (p&lt;0.0001). The mean (SD) CHAD<jats:sub>2<\/jats:sub>S<jats:sub>2<\/jats:sub>-VASc scores were 4.5 (1.9) for White patients, and 5.3 (1.9) for Black patients with p&lt;0.0001, respectively. Black patients (vs White patients) had a higher non-treatment (no DOAC or warfarin) rate (56.1% vs 47.4%, p&lt;0.0001) across the US which was particularly notable in the southeast. In addition, treatment rates were highly variable within each US state. Counties with dense population more frequently demonstrated significant differences by race than counties with sparse population.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Our study showed differences in the use of OACs across US counties and among various racial groups. These disparities highlighted the areas of unmet need for both Black and White patients.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0314345","type":"journal-article","created":{"date-parts":[[2024,12,12]],"date-time":"2024-12-12T18:47:43Z","timestamp":1734029263000},"page":"e0314345","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Racial differences and geographic variations in oral anticoagulation treatment among Medicare patients with non-valvular atrial fibrillation"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0195-1081","authenticated-orcid":true,"given":"Larry R.","family":"Jackson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amiee","family":"Kang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia","family":"Noxon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nipun","family":"Atreja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dionne M.","family":"Hines","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Hagan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett D.","family":"Atwater","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,12,12]]},"reference":[{"issue":"8","key":"pone.0314345.ref001","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1016\/j.amjcard.2013.05.063","article-title":"Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population","volume":"112","author":"S Colilla","year":"2013","journal-title":"Am J Cardiol"},{"issue":"8","key":"pone.0314345.ref002","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1161\/01.STR.22.8.983","article-title":"Atrial fibrillation as an independent risk factor for stroke: the Framingham Study","volume":"22","author":"PA Wolf","year":"1991","journal-title":"Stroke"},{"issue":"6","key":"pone.0314345.ref003","doi-asserted-by":"crossref","first-page":"e0179687","DOI":"10.1371\/journal.pone.0179687","article-title":"Risk of ischemic stroke after atrial fibrillation diagnosis: A national sample cohort","volume":"12","author":"MK Son","year":"2017","journal-title":"PLoS One"},{"key":"pone.0314345.ref004","unstructured":"Prevention CfDCa. 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