Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, Florida, United States of America.
Department of Pharmacy and Therapeutics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
PLoS One. 2024 Jan 29;19(1):e0297208. doi: 10.1371/journal.pone.0297208. eCollection 2024.
Prior studies have shown disparities in the uptake of cardioprotective newer glucose-lowering drugs (GLDs), including sodium-glucose cotranwsporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1a). This study aimed to characterize geographic variation in the initiation of newer GLDs and the geographic variation in the disparities in initiating these medications.
Using 2017-2018 claims data from a 15% random nationwide sample of Medicare Part D beneficiaries, we identified individuals diagnosed with type 2 diabetes (T2D), who had ≥1 GLD prescriptions, and did not use SGLT2i or GLP1a in the year prior to the index date,1/1/2018. Patients were followed up for a year. The cohort was spatiotemporally linked to Dartmouth hospital-referral regions (HRRs), with each patient assigned to 1 of 306 HRRs. We performed multivariable Poisson regression to estimate adjusted initiation rates, and multivariable logistic regression to assess racial disparities in each HRR.
Among 795,469 individuals with T2D included in the analyses, the mean (SD) age was 73 (10) y, 53.3% were women, 12.2% were non-Hispanic Black, and 7.2% initiated a newer GLD in the follow-up year. In the adjusted model including clinical factors, compared to non-Hispanic White patients, non-Hispanic Black (initiation rate ratio, IRR [95% CI]: 0.66 [0.64-0.68]), American Indian/Alaska Native (0.74 [0.66-0.82]), Hispanic (0.85 [0.82-0.87]), and Asian/Pacific islander (0.94 [0.89-0.98]) patients were less likely to initiate newer GLDs. Significant geographic variation was observed across HRRs, with an initiation rate spanning 2.7%-13.6%.
This study uncovered substantial geographic variation and the racial disparities in initiating newer GLDs.
先前的研究表明，在使用新型降糖药物（GLD）方面存在差异，包括钠-葡萄糖协同转运蛋白 2 抑制剂（SGLT2i）和胰高血糖素样肽-1 受体激动剂（GLP1a）。本研究旨在描述新型 GLD 起始使用的地域差异以及起始这些药物使用的地域差异。
利用 2017-2018 年来自 Medicare 处方药计划 15%随机全国样本的索赔数据，我们确定了诊断为 2 型糖尿病（T2D）的患者，他们有≥1 次 GLD 处方，并且在索引日期（2018 年 1 月 1 日）之前的 1 年内没有使用 SGLT2i 或 GLP1a。对患者进行了为期 1 年的随访。该队列与达特茅斯医院转诊区（HRR）进行时空链接，每个患者被分配到 306 个 HRR 中的 1 个。我们使用多变量泊松回归估计调整后的起始率，并使用多变量逻辑回归评估每个 HRR 中的种族差异。
在纳入分析的 795469 名 T2D 患者中，平均（SD）年龄为 73（10）岁，53.3%为女性，12.2%为非西班牙裔黑人，7.2%在随访年内开始使用新型 GLD。在包括临床因素的调整模型中，与非西班牙裔白人患者相比，非西班牙裔黑人（起始率比 [95%CI]：0.66 [0.64-0.68]）、美国印第安人/阿拉斯加原住民（0.74 [0.66-0.82]）、西班牙裔（0.85 [0.82-0.87]）和亚裔/太平洋岛民（0.94 [0.89-0.98]）患者不太可能开始使用新型 GLD。在 HRR 之间观察到显著的地域差异，起始率为 2.7%-13.6%。
本研究发现新型 GLD 起始使用存在显著的地域差异和种族差异。
