Race- and Neighborhood-Level Social Determinants of Health in Diagnosis and Treatment of Atrial Fibrillation

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.