Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia.
JAMA Netw Open. 2021 Apr 1;4(4):e216139. doi: 10.1001/jamanetworkopen.2021.6139.
Sodium-glucose cotransporter 2 (SGLT2) inhibitors significantly reduce deaths from cardiovascular conditions, hospitalizations for heart failure, and progression of kidney disease among patients with type 2 diabetes. Black individuals have a disproportionate burden of cardiovascular and chronic kidney disease (CKD). Adoption of novel therapeutics has been slower among Black and female patients and among patients with low socioeconomic status than among White or male patients or patients with higher socioeconomic status.
To assess whether inequities based on race/ethnicity, gender, and socioeconomic status exist in SGLT2 inhibitor use among patients with type 2 diabetes in the US.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study of commercially insured patients in the US was performed from October 1, 2015, to June 30, 2019, using the Optum Clinformatics Data Mart. Adult patients with a diagnosis of type 2 diabetes, including those with heart failure with reduced ejection fraction (HFrEF), atherosclerotic cardiovascular disease (ASCVD), or CKD, were evaluated in the analysis.
Prescription of an SGLT2 inhibitor. Multivariable logistic regression models were used to assess the association of race/ethnicity, gender, and socioeconomic status with SGLT2 inhibitor use.
Of 934 737 patients with type 2 diabetes (mean [SD] age, 65.4 [12.9] years; 50.7% female; 57.6% White), 81 007 (8.7%) were treated with an SGLT2 inhibitor during the study period. Between 2015 and 2019, the percentage of patients with type 2 diabetes treated with an SGLT2 inhibitor increased from 3.8% to 11.9%. Among patients with type 2 diabetes and cardiovascular or kidney disease, the rate of SGLT2 inhibitor use increased but was lower than that among all patients with type 2 diabetes (HFrEF: 1.9% to 7.6%; ASCVD: 3.0% to 9.8%; CKD: 2.1% to 7.5%). In multivariable analyses, Black race (adjusted odds ratio [aOR], 0.83; 95% CI, 0.81-0.85), Asian race (aOR, 0.94; 95% CI, 0.90-0.98), and female gender (aOR, 0.84; 95% CI, 0.82-0.85) were associated with lower rates of SGLT2 inhibitor use, whereas higher median household income (≥$100 000: aOR, 1.08 [95% CI, 1.05-1.10]; $50 000-$99 999: aOR, 1.05 [95% CI, 1.03-1.07] vs <$50 000) was associated with a higher rate of SGLT2 inhibitor use. These results were similar among patients with HFrEF, ASCVD, and CKD.
In this cohort study, use of an SGLT2 inhibitor treatment increased among patients with type 2 diabetes from 2015 to 2019 but remained low, particularly among patients with HFrEF, CKD, and ASCVD. Black and female patients and patients with low socioeconomic status were less likely to receive an SGLT2 inhibitor, suggesting that interventions to ensure more equitable use are essential to prevent worsening of well-documented disparities in cardiovascular and kidney outcomes in the US.
钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂可显著降低 2 型糖尿病患者心血管疾病的死亡率、心力衰竭住院率和肾脏疾病进展。黑人患有心血管疾病和慢性肾脏病（CKD）的负担不成比例。与白人或男性患者或社会经济地位较高的患者相比，黑人、女性患者以及社会经济地位较低的患者采用新的治疗方法的速度较慢。
评估美国 2 型糖尿病患者使用 SGLT2 抑制剂是否存在基于种族/民族、性别和社会经济地位的差异。
设计、地点和参与者：这是一项在美国进行的回顾性队列研究，使用 Optum Clinformatics Data Mart，从 2015 年 10 月 1 日至 2019 年 6 月 30 日对商业保险患者进行了评估。分析中评估了患有 2 型糖尿病（包括射血分数降低型心力衰竭[HFrEF]、动脉粥样硬化性心血管疾病[ASCVD]或 CKD 的患者）的成年患者。
处方 SGLT2 抑制剂。使用多变量逻辑回归模型评估种族/民族、性别和社会经济地位与 SGLT2 抑制剂使用之间的关联。
在 934737 例患有 2 型糖尿病的患者中（平均[标准差]年龄 65.4[12.9]岁；50.7%为女性；57.6%为白人），81007 例（8.7%）在研究期间接受了 SGLT2 抑制剂治疗。2015 年至 2019 年间，接受 SGLT2 抑制剂治疗的 2 型糖尿病患者比例从 3.8%上升至 11.9%。在患有心血管或肾脏疾病的 2 型糖尿病患者中，SGLT2 抑制剂的使用率有所增加，但仍低于所有 2 型糖尿病患者（HFrEF：1.9%至 7.6%；ASCVD：3.0%至 9.8%；CKD：2.1%至 7.5%）。在多变量分析中，黑人种族（调整后的优势比[aOR]，0.83；95%置信区间[CI]，0.81-0.85）、亚洲种族（aOR，0.94；95%CI，0.90-0.98）和女性性别（aOR，0.84；95%CI，0.82-0.85）与 SGLT2 抑制剂使用率较低相关，而较高的中位家庭收入（≥$100000：aOR，1.08[95%CI，1.05-1.10]；$50000-$99999：aOR，1.05[95%CI，1.03-1.07] vs <$50000）与 SGLT2 抑制剂使用率较高相关。这些结果在 HFrEF、ASCVD 和 CKD 患者中相似。
在这项队列研究中，2015 年至 2019 年期间，2 型糖尿病患者使用 SGLT2 抑制剂的治疗有所增加，但仍处于较低水平，尤其是在 HFrEF、CKD 和 ASCVD 患者中。黑人、女性患者和社会经济地位较低的患者接受 SGLT2 抑制剂的可能性较低，这表明需要采取干预措施确保更公平地使用，以防止美国心血管和肾脏结局方面已证实的差异进一步恶化。
