Explaining Racial Disparities in Anticoagulation Control: Results From a Study of Patients at the Veterans Administration

Sowmya R. Rao*, Joel I. Reisman, Nancy R. Kressin, Dan R. Berlowitz, Arlene S. Ash, Al Ozonoff, Donald R. Miller, Elaine M. Hylek, Shibei Zhao, Adam J. Rose

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Higher rates of stroke, major hemorrhage, and death among black patients receiving warfarin, compared with white patients, is likely related to poorer anticoagulation control. The research team investigated patient-level and site-level factors that might account for this group difference. A summary measure of anticoagulation control (percent time in therapeutic range [TTR]), patient characteristics, and site-level process of care measures were obtained for 9572 black and 88 481 white patients at the Veterans Health Administration. The research team studied disparity in TTR adjusting for patient and site characteristics. Mean unadjusted TTR for black patients was 6.5% lower than for white patients (P <.001). After accounting for the younger age of blacks, greater degrees of medication use, hospitalization, poverty, living in the South, and 11 other patient characteristics, only 2.0% of this racial disparity persisted. Process of care measures had minimal additional effect. These findings may inform efforts to reduce this racial disparity in achieving good anticoagulation control.

Original languageAmerican English
Pages (from-to)214-222
Number of pages9
JournalAmerican Journal of Medical Quality
Issue number3
StatePublished - 11 May 2015
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2014 by the American College of Medical Quality


  • anticoagulants
  • quality of health care
  • racial and ethnic disparities
  • warfarin


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