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, suggesting patient-physician concordance as a potential pathway to support more equitable anticoagulation care.
Key Findings
Results
Patient-physician race and ethnicity concordance was associated with increased odds of DOAC therapy initiation among eligible NVAF patients.
Odds ratio for DOAC initiation with race/ethnicity concordance: OR 1.19 (95% CI, 1.14-1.24)
Of 59,340 DOAC therapy-eligible patients, 34,281 (57.8%) had a DOAC prescription order within 60 days of initial NVAF diagnosis
Analysis used multivariable logistic regression models accounting for age, sex, patient race and ethnicity, health insurance type, and neighborhood deprivation index
Study conducted using Kaiser Permanente Southern California electronic health records from January 1, 2012 through December 31, 2022
Results
Both patient-physician race/ethnicity concordance and language concordance were associated with increased odds of DOAC therapy persistence at one year.
Race/ethnicity concordance was associated with increased persistence: OR 1.08 (95% CI, 1.03-1.14)
Language concordance was associated with increased persistence: OR 1.14 (95% CI, 1.04-1.24)
Persistence was defined as 1 year of continuous DOAC prescription fills without a gap of 60 or more days
Among 34,215 patients with a DOAC prescription fill, only 45.3% were persistent with DOAC therapy for 1 year
Results
Among Hispanic patients specifically, race/ethnicity concordance was associated with increased DOAC initiation and language concordance was associated with increased DOAC persistence.
Hispanic patient-physician race/ethnicity concordance was associated with DOAC initiation: OR 1.39 (95% CI, 1.22-1.58)
Language concordance among Hispanic patients was associated with DOAC persistence: OR 1.12 (95% CI, 1.01-1.24)
Hispanic patients comprised 12,440 (21.0%) of the total cohort
The association for Hispanic patients was notably stronger than the overall cohort effect for initiation (OR 1.39 vs. OR 1.19)
Results
Neither race/ethnicity nor language concordance was associated with DOAC therapy initiation or persistence among non-Hispanic Black patients.
Race/ethnicity concordance ORs for non-Hispanic Black patients: OR 1.04 (95% CI, 0.78-1.39) for initiation and OR 1.03 (95% CI, 0.72-1.47) for persistence
Language concordance ORs for non-Hispanic Black patients: OR 0.61 (95% CI, 0.24-1.55) for initiation and OR 1.62 (95% CI, 0.53-4.93) for persistence
Non-Hispanic Black patients comprised 5,374 (9.1%) of the total cohort
All confidence intervals for non-Hispanic Black patients crossed 1.0, indicating no statistically significant associations
Methods
The study cohort was predominantly older, female, and non-Hispanic White, with a substantial proportion of minority patients.
Mean age was 76.9 (SD 9.1) years; 32,889 (55.4%) were female
Racial/ethnic composition: 35,645 (60.1%) non-Hispanic White, 12,440 (21.0%) Hispanic, 5,374 (9.1%) non-Hispanic Black, and 4,803 (8.1%) non-Hispanic Asian
All patients had a confirmed NVAF diagnosis and a CHA2DS2-VASc score of 2 or higher, making them eligible for DOAC therapy
The retrospective cohort study included 59,340 total eligible patients
What This Means
This research suggests that when patients with atrial fibrillation (an irregular heart rhythm that increases stroke risk) see doctors who share their racial, ethnic, or language background, they are more likely to be prescribed and to keep taking blood thinners called direct oral anticoagulants (DOACs). The study looked at over 59,000 patients at Kaiser Permanente Southern California over a decade. Overall, only about 58% of eligible patients received a DOAC prescription within 60 days of diagnosis, and among those who did, fewer than half continued taking the medication consistently for a full year — highlighting a significant gap in care.
The findings were particularly strong for Hispanic patients, who were substantially more likely to start DOAC treatment when their doctor shared their racial or ethnic background, and more likely to continue treatment when their doctor spoke the same language. In contrast, for non-Hispanic Black patients, having a racially concordant or language-concordant physician did not show a statistically significant association with either starting or continuing treatment, suggesting that other barriers to equitable care may be more prominent for this group.
This research suggests that patient-physician concordance — matching patients with providers who share their background or language — could be one strategy to help reduce racial and ethnic disparities in anticoagulation treatment for atrial fibrillation. However, the findings also indicate that concordance alone is unlikely to be a universal solution, as it did not appear to benefit all racial and ethnic groups equally, pointing to the need for multiple, tailored approaches to achieve equitable cardiovascular care.
Au M, Zhou M, Lee M, An J. (2026). Race, Ethnicity, and Language Concordance Between Patients and Physicians and Atrial Fibrillation DOAC Treatment.. JAMA network open. https://doi.org/10.1001/jamanetworkopen.2026.29363