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Lower socioeconomic status may confer hemorrhage risk in older adults using warfarin
Among older patients with atrial fibrillation using warfarin, lower socioeconomic status was associated with a greater risk for hemorrhage and hemorrhage-related mortality.
Researchers conducted a population-based cohort study of 166,742 adults aged 66 years and older. All patients had AF and were receiving continuous treatment with warfarin. The researchers linked Statistics Canada Census information with individual postal codes to acquire median neighborhood income levels. The patients were then divided based on income levels. The median follow-up was 369 days.
The primary outcome was ED visit or hospitalization for hemorrhage. Overall, 9.8% of patients were hospitalized for hemorrhage during the study period.
Compared with the highest-income quintile, patients in the lowest-income quintile had an increased risk for fatal hemorrhage (adjusted HR = 1.28; 95% CI, 1.11-1.48) and hospitalization due to hemorrhage (adjusted HR = 1.18; 95% CI, 1.12-1.23) after multivariable adjustment using Cox proportional hazards regression.
The crude rate of hemorrhage during continuous warfarin therapy ranged from 5.3% per person-year in the lowest-income quintile to 4.3% per person-year in the highest-income quintile.
Analysis based on hemorrhage subtype indicated that patients in the lowest-income quintile had a greater risk for gastrointestinal hemorrhage (adjusted HR = 1.18; 95% CI, 1.1-1.27) and other types of hemorrhage (adjusted HR = 1.2; 95% CI, 1.12-1.29) compared with patients in the highest-income quintile. The researchers found no correlation between income and risk for intracranial hemorrhage.
According to the researchers, results of this study could be used to guide warfarin prescribing habits for patients with lower socioeconomic status.
“Integrating this evidence into patient counseling, warfarin prescribing and anticoagulation monitoring practices may help reduce socioeconomic status-related health disparities and reduce the burden of warfarin-mediated harm,” the researchers concluded. – by Jennifer Byrne
Disclosure: One researcher reports serving on the advisory boards and/or receiving honoraria from AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Hoffmann-La Roche, Novartis, Novo Nordisk and Pfizer.