Chen Alissa S, Brunetto Wendy, Canavan Maureen E, Lipska Kasia J, Richey Elizabeth, Wilson Madeline S, Zarro James, Ross Joseph S
National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
J Gen Intern Med. 2025 Jun 30. doi: 10.1007/s11606-025-09691-4.
While glucagon-like peptide-1 receptor agonists and dual glucagon-like peptide-1 receptor/GIP agonists (GLPs) have revolutionized the treatment of obesity, national data shows Black patients, Hispanic patients, and patients of lower socioeconomic status are less likely to receive anti-obesity medications.
To assess the association between Black race, Hispanic ethnicity, and low socioeconomic status on GLP prescription receipt for adults in a university-based staff model health maintenance organization (HMO).
Cross-sectional study using electronic health record data.
Adults (≥ 18 years) enrolled in Yale Health with a body mass index (BMI) ≥ 27 kg/m2 with at least one obesity-related condition or BMI ≥ 30 kg/m without diabetes.
The main outcome measure was receipt of a GLP prescription for obesity treatment, including subcutaneous liraglutide, semaglutide, or tirzepatide. Main independent variables of interest included self-reported race (Asian, Black, White, Other, and Missing), ethnicity (Hispanic, non-Hispanic), and area deprivation index (ADI) quintile. Three logistic regression models examined the association of race, ethnicity, and socioeconomic status on prescription receipt: 1) an unadjusted model, 2) an adjusted model for age, sex, and clinical characteristics, and 3) an adjusted model with socioeconomic status.
Among 6,225 eligible patients, 1,143 (18.3%) were prescribed a GLP. Black patients (21.5%) and Hispanic (23.1%) patients had higher prevalence of prescriptions compared to White patients (17.5%; p < 0.001) and non-Hispanic patients (18.1%; p < 0.001). In adjusted models, Black patients (OR = 0.94 [0.78-1.13]) and lowest ADI quintile patients (OR = 0.87 [0.65-1.16]) did not have statistically different odds of receiving a GLP prescription compared to White patients and the highest ADI quintile patients. Hispanic patients had slightly increased adjusted odds of prescription receipt compared to non-Hispanic patients (OR = 1.27 [1.00-1.63]).
In a university-based staff model HMO, there were no disparities in receipt of GLP prescriptions for obesity across racial, ethnic, or socioeconomic groups.
虽然胰高血糖素样肽-1受体激动剂和双胰高血糖素样肽-1受体/葡萄糖依赖性促胰岛素多肽激动剂（GLP）彻底改变了肥胖症的治疗方式，但全国数据显示，黑人患者、西班牙裔患者以及社会经济地位较低的患者接受抗肥胖药物治疗的可能性较小。
评估在一个基于大学教职工模式的健康维护组织（HMO）中，黑人种族、西班牙裔族裔和低社会经济地位与成人GLP处方开具之间的关联。
使用电子健康记录数据进行横断面研究。
耶鲁健康中心登记的成年人（≥18岁），体重指数（BMI）≥27kg/m²且患有至少一种肥胖相关疾病，或BMI≥30kg/m²且无糖尿病。
主要结局指标是开具用于肥胖症治疗的GLP处方，包括皮下注射利拉鲁肽、司美格鲁肽或替尔泊肽。主要感兴趣的自变量包括自我报告的种族（亚洲人、黑人、白人、其他和缺失）、族裔（西班牙裔、非西班牙裔）以及地区贫困指数（ADI）五分位数。三个逻辑回归模型检验了种族、族裔和社会经济地位与处方开具之间的关联：1）未调整模型；2）调整年龄、性别和临床特征后的模型；3）调整社会经济地位后的模型。
在6225名符合条件的患者中，1143名（18.3%）患者开具了GLP处方。黑人患者（21.5%）和西班牙裔患者（23.1%）的处方患病率高于白人患者（17.5%；p<0.001）和非西班牙裔患者（18.1%；p<0.001）。在调整后的模型中，与白人患者和ADI五分位数最高的患者相比，黑人患者（OR = 0.94 [0.78 - 1.13]）和ADI五分位数最低的患者（OR = 0.87 [0.65 - 1.16]）接受GLP处方的几率在统计学上没有差异。与非西班牙裔患者相比，西班牙裔患者处方开具的调整后几率略有增加（OR = 1.27 [1.00 - 1.63]）。
在一个基于大学教职工模式的HMO中，不同种族、族裔或社会经济群体在接受肥胖症GLP处方方面没有差异。
