In this retrospective claims-based cohort of greater Philadelphia residents, AF diagnosis rates declined with worsening neighborhood-level disadvantage among non-Hispanic Black individuals but increased among non-Hispanic White individuals, while anticoagulant prescription conditional on diagnosis was similar across race and ethnicity groups.
Non-Hispanic Black patients were less likely than non-Hispanic White patients to be diagnosed with AF, with an effect at the margin of statistical significance.
The race-related difference in AF diagnosis widened with increasing neighborhood disadvantage, as shown by a significant race-by-SBI interaction.
The association between neighborhood SBI and AF diagnosis ran in opposite directions for Black and White individuals.
Among patients diagnosed with AF, 58% had an anticoagulant prescription, and the race-by-SBI interaction for anticoagulant prescription was significant at the margin.
Conditional on an AF diagnosis, anticoagulant prescription rates were similar across race and ethnicity groups.
The study population was middle-aged and majority female, drawn from Medicare Advantage and commercially insured individuals.
The authors conclude that targeted interventions in more marginalized neighborhoods are needed to increase AF detection.
This study used insurance claims from over 500,000 people in the greater Philadelphia area to look at who gets diagnosed with atrial fibrillation (AF), an irregular heart rhythm that raises the risk of stroke, and who receives blood-thinning medication. About 5% were diagnosed with AF. Black patients were slightly less likely than White patients to be diagnosed, and this gap grew in more disadvantaged neighborhoods. The pattern differed by race. Among White individuals, living in a more disadvantaged neighborhood was linked to higher odds of an AF diagnosis, whereas among Black individuals it was linked to lower odds. This may suggest that AF goes undetected in Black residents of disadvantaged neighborhoods, though the study cannot say why. Once people were diagnosed, about 58% had a blood thinner prescription, and rates were broadly similar across racial groups. This research suggests that efforts to close gaps in AF care may need to focus on detection, especially in marginalized neighborhoods, rather than only on treatment after diagnosis. The study is based on insurance claims in one region among insured people, so the findings may not apply to uninsured people or other areas, and it shows associations rather than causes.
Amagai K, Nadji A, Berkowitz M, Venkataramani A, Dixon E. (2026). Race- and Neighborhood-Level Social Determinants of Health in Diagnosis and Treatment of Atrial Fibrillation.. JAMA network open. https://doi.org/10.1001/jamanetworkopen.2026.40279