Racial, Ethnic, and Socioeconomic Inequities in Glucagon-Like Peptide-1 Receptor Agonist Use Among Patients With Diabetes in the US.
Racial, Ethnic, and Socioeconomic Inequities in Glucagon-Like Peptide-1 Receptor Agonist Use Among Patients With Diabetes in the US.
复制标题
DOI：
10.1001/jamahealthforum.2021.4182
复制
发表时间：
2021-12
期刊：
影响因子：
--
通讯作者：
Adusumalli S
中科院分区：
文献类型：
--
作者：
Eberly LA;Yang L;Essien UR;Eneanya ND;Julien HM;Luo J;Nathan AS;Khatana SAM;Dayoub EJ;Fanaroff AC;Giri J;Groeneveld PW;Adusumalli S
在美国糖尿病患者中，胰高血糖素样肽-1受体激动剂（GLP-1 RA）的使用是否存在基于种族、民族、性别和社会经济地位的不平等？这项针对美国1180260名商业保险糖尿病患者的5年队列研究发现，GLP-1 RA的使用增加了，但仍然很低。GLP-1 RA的使用率在亚裔、黑人和西班牙裔人群以及家庭收入较低的人群中较低；同时患有心血管疾病的糖尿病患者的结果相似。这项队列研究的结果表明，在获得GLP-1 RA方面存在种族、民族和社会经济不平等，GLP-1 RA是一种改善糖尿病患者心血管结局的药物。随机临床试验表明，胰高血糖素样肽-1受体激动剂（GLP-1 RAs）可显著减轻2型糖尿病（T2D）患者的体重并减少心血管事件。黑人患者有不成比例的肥胖和心血管疾病负担，心血管相关死亡率更高。健康结果的种族和民族差异主要归因于普遍存在的结构性种族主义，而被种族主义边缘化的患者获得新疗法的机会较少。评估商业保险人群中T2D患者对GLP-1 RA的摄取；确定种族、民族、性别和社会经济地位与GLP-1 RA使用的关系；并特别检查其在动脉粥样硬化性心血管疾病（ASCVD）患者亚组中的使用，因为已知GLP-1 RA对该人群有益。这是一项回顾性队列分析，使用来自OptumInsight临床数据集市的数据，研究对象是美国商业保险的成年T2D患者（伴有或不伴有ASCVD）。纳入2015年10月1日至2019年6月31日的数据，并于2020年7月进行分析。我们估计了多变量logistic回归模型，以确定种族、民族、性别和社会经济地位与GLP-1 RA使用的关系。GLP-1 RA的处方。在1 18260例T2D患者（中位[IQR]年龄69[59-76]岁；50.3%女性；57.7%白人）中，研究期间90934例（7.7%）患者接受GLP-1 RA治疗。从2015年到2019年，接受GLP-1 RA治疗的T2D患者比例从3.2%上升到10.7%。在T2D和ASCVD患者中，使用也有所增加，但仍然很低（2.8%-9.4%）。在多变量分析中，亚洲（aOR, 0.59; 95% CI, 0.56-0.62）、黑人（调整优势比[aOR] 0.81; 95% CI, 0.79-0.83）和西班牙裔（aOR, 0.91; 95% CI, 0.88-0.93） T2D患者中GLP-1 RA的使用率较低。女性（aOR, 1.22; 95% CI, 1.20-1.24）和较高的邮政编码相关的家庭收入中位数（10万美元[OR， 1.13; 95% CI, 1.11-1.16]和5万美元- 99 999美元[OR， 1.07; 95% CI, 1.05-1.09] vs < 5万美元）与较高的GLP-1 RA使用相关。这些结果与ASCVD患者的结果相似。在这项针对美国T2D患者的队列研究中，GLP-1 RA的使用有所增加，但在T2D治疗中总体仍处于较低水平，特别是在可能获得最大获益的ASCVD患者中。亚裔、黑人和西班牙裔患者以及低收入患者接受GLP-1 RA治疗的可能性较小。在美国，需要降低GLP-1 RA使用障碍的策略，例如降低成本，以防止心血管疾病结局的不公平现象扩大。本队列研究考察了美国2型糖尿病患者使用胰高血糖素样肽-1受体激动剂相关的种族、民族、性别和社会经济不平等。
Are there inequities in glucagon-like peptide-1 receptor agonist (GLP-1 RA) use based on race, ethnicity, sex, and socioeconomic status among patients with diabetes in the US? This 5-year cohort study of 1 180 260 commercially insured patients with diabetes in the US found that GLP-1 RA use increased but use remained low. Lower rates of GLP-1 RA use were found among Asian, Black, and Hispanic individuals and among those with lower household income; results were similar among patients with diabetes who also had cardiovascular disease. The findings of this cohort study suggest that racial, ethnic, and socioeconomic inequities are present in access to GLP-1 RA, a medication with established benefits for improved cardiovascular outcomes in patients with diabetes. Randomized clinical trials have shown that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) cause significant weight loss and reduce cardiovascular events in patients with type 2 diabetes (T2D). Black patients have a disproportionate burden of obesity and cardiovascular disease and have a higher rate of cardiovascular-related mortality. Racial and ethnic disparities in health outcomes are largely attributable to the pervasiveness of structural racism, and patients who are marginalized by racism have less access to novel therapeutics. To evaluate GLP-1 RA uptake among a commercially insured population of patients with T2D; identify associations of race, ethnicity, sex, and socioeconomic status with GLP-1 RA use; and specifically examine its use among the subgroup of patients with atherosclerotic cardiovascular disease (ASCVD) because of the known benefit of GLP-1 RA use for this population. This was a retrospective cohort analysis using data from OptumInsight Clinformatics Data Mart of commercially insured adult patients with T2D (with or without ASCVD) in the US. Data from October 1, 2015, to June 31, 2019, were included, and the analyses were performed in July 2020. We estimated multivariable logistic regression models to identify the association of race, ethnicity, sex, and socioeconomic status with GLP-1 RA use. A prescription for a GLP-1 RA. Of the 1 180 260 patients with T2D (median [IQR] age, 69 [59-76] years; 50.3% female; 57.7% White), 90 934 (7.7%) were treated with GLP-1 RA during the study period. From 2015 to 2019, the percentage of T2D patients treated with an GLP-1 RA increased from 3.2% to 10.7%. Among patients with T2D and ASCVD, use also increased but remained low (2.8%-9.4%). In multivariable analyses, lower rates of GLP-1 RA use were found among Asian (aOR, 0.59; 95% CI, 0.56-0.62), Black (adjusted odds ratio [aOR] 0.81; 95% CI, 0.79-0.83), and Hispanic (aOR, 0.91; 95% CI, 0.88-0.93) patients with T2D. Female sex (aOR, 1.22; 95% CI, 1.20-1.24) and higher zip code–linked median household incomes (>$100 000 [OR, 1.13; 95% CI, 1.11-1.16] and $50 000-$99 999 [OR, 1.07; 95% CI, 1.05-1.09] vs <$50 000) were associated with higher GLP-1 RA use. These results were similar to those found among patients with ASCVD. In this cohort study of US patients with T2D, GLP-1 RA use increased, but remained low overall for treatment of T2D, particularly among patients with ASCVD who are likely to derive the most benefit. Asian, Black, and Hispanic patients and those with low income were less likely to receive treatment with a GLP-1 RA. Strategies to lower barriers to GLP-1 RA use, such as lower cost, are needed to prevent the widening of well-documented inequities in cardiovascular disease outcomes in the US. This cohort study examines the racial, ethnic, sex, and socioeconomic inequities associated with use of glucagon-like peptide-1 receptor agonists in US patients with type 2 diabetes.
登录
查看更多内容
影响因子：
16.2
作者：
通讯作者：
--
影响因子：
13.8
作者：
Eberly LA;Garg L;Yang L;Markman TM;Nathan AS;Eneanya ND;Dixit S;Marchlinski FE;Groeneveld PW;Frankel DS
通讯作者：
Frankel DS
DOI：
10.1056/nejmoa1603827
发表时间：
2016-07-28
期刊：
The New England journal of medicine
影响因子：
--
作者：
Marso SP;Daniels GH;Brown-Frandsen K;Kristensen P;Mann JF;Nauck MA;Nissen SE;Pocock S;Poulter NR;Ravn LS;Steinberg WM;Stockner M;Zinman B;Bergenstal RM;Buse JB;LEADER Steering Committee;LEADER Trial Investigators
通讯作者：
LEADER Trial Investigators
影响因子：
9.7
作者：
Eberly, Lauren A.;Richterman, Aaron;Zon, Rebecca
通讯作者：
Zon, Rebecca
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN