Association of Race/Ethnicity, Gender, and Socioeconomic Status With Sodium-Glucose Cotransporter 2 Inhibitor Use Among Patients With Diabetes in the US.
Association of Race/Ethnicity, Gender, and Socioeconomic Status With Sodium-Glucose Cotransporter 2 Inhibitor Use Among Patients With Diabetes in the US.
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DOI：
10.1001/jamanetworkopen.2021.6139
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发表时间：
2021-04-01
影响因子：
13.8
通讯作者：
Adusumalli S
中科院分区：
文献类型：
--
作者：
Eberly LA;Yang L;Eneanya ND;Essien U;Julien H;Nathan AS;Khatana SAM;Dayoub EJ;Fanaroff AC;Giri J;Groeneveld PW;Adusumalli S
本队列研究评估了在美国2型糖尿病患者中，钠-葡萄糖共转运蛋白2 （SGLT2）抑制剂的使用是否存在种族/民族、性别和社会经济地位的不平等。在美国2型糖尿病患者中，种族/民族、性别和社会经济地位是否与钠-葡萄糖共转运蛋白2 （SGLT2）抑制剂的使用有关？在一项针对934737名美国商业保险2型糖尿病患者的5年队列研究中，SGLT2抑制剂的使用频率增加，但即使在心力衰竭、肾脏疾病和心血管疾病患者中，SGLT2抑制剂的使用仍然很低。黑人、女性和较低的家庭收入与较低的SGLT2抑制剂使用率相关。在这项研究中，在获得SGLT2抑制剂治疗方面存在种族/民族、性别和社会经济不平等，如果不加以解决，可能会扩大美国肾脏和心血管结局的差异。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、心力衰竭住院和肾脏疾病进展的死亡率。黑人有不成比例的心血管和慢性肾脏疾病（CKD）负担。黑人和女性患者以及社会经济地位较低的患者采用新疗法的速度比白人或男性患者或社会经济地位较高的患者慢。评估美国2型糖尿病患者在使用SGLT2抑制剂方面是否存在基于种族/民族、性别和社会经济地位的不平等。2015年10月1日至2019年6月30日，使用Optum临床数据集市对美国商业保险患者进行了回顾性队列研究。诊断为2型糖尿病的成年患者，包括心力衰竭伴射血分数降低（HFrEF）、动脉粥样硬化性心血管疾病（ASCVD）或CKD患者，在分析中进行了评估。处方SGLT2抑制剂。使用多变量logistic回归模型来评估种族/民族、性别和社会经济地位与SGLT2抑制剂使用的关系。在934737例2型糖尿病患者（平均[SD]年龄65.4[12.9]岁；50.7%女性；57.6%白人）中，81007例（8.7%）患者在研究期间接受了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2型糖尿病合并心血管或肾脏疾病的患者中，SGLT2抑制剂的使用率增加，但低于所有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（校正优势比[aOR]， 0.83; 95% CI, 0.81-0.85）、亚洲种族（aOR, 0.94; 95% CI, 0.90-0.98）和女性（aOR, 0.84; 95% CI, 0.82-0.85）与SGLT2抑制剂使用率较低相关，而较高的家庭收入中位数（≥10万美元：aOR， 1.08 [95% CI, 1.05- 1.07] vs < 5万美元：aOR， 1.05 [95% CI, 1.03-1.07] vs < 5万美元）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，从2015年到2019年，2型糖尿病患者使用SGLT2抑制剂治疗增加，但仍然很低，特别是在HFrEF、CKD和ASCVD患者中。黑人和女性患者以及社会经济地位较低的患者接受SGLT2抑制剂的可能性较小，这表明确保更公平使用的干预措施对于防止美国心血管和肾脏结果的差异恶化至关重要。
This cohort study evaluates whether inequities in race/ethnicity, gender, and socioeconomic status exist in sodium-glucose cotransporter 2 (SGLT2) inhibitor use among US patients with type 2 diabetes. Are race/ethnicity, gender, and socioeconomic status associated with use of sodium-glucose cotransporter 2 (SGLT2) inhibitors among patients with type 2 diabetes in the US? In a 5-year cohort study of 934 737 commercially insured US patients with type 2 diabetes, the frequency of SGLT2 inhibitor use increased, but use remained low even among patients with heart failure, kidney disease, and cardiovascular disease. Black race, female gender, and lower household income were associated with lower rates of SGLT2 inhibitor use. In this study, racial/ethnic, gender, and socioeconomic inequities were present in access to SGLT2 inhibitor treatment, which if unaddressed, may widen disparities in kidney and cardiovascular outcomes in the US. 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. 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.
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影响因子：
37.8
作者：
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通讯作者：
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DOI：
10.1161/circoutcomes.116.003476
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