Geographic variation and racial disparities in adoption of newer glucose-lowering drugs with cardiovascular benefits among US Medicare beneficiaries with type 2 diabetes.
Geographic variation and racial disparities in adoption of newer glucose-lowering drugs with cardiovascular benefits among US Medicare beneficiaries with type 2 diabetes.
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DOI：
10.1371/journal.pone.0297208
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发表时间：
2024
期刊：
影响因子：
3.7
通讯作者：
Guo, Jingchuan
中科院分区：
文献类型：
--
作者：
Chen, Wei-Han;Li, Yujia;Yang, Lanting;Allen, John M.;Shao, Hui;Donahoo, William T.;Billelo, Lori;Hu, Xia;Shenkman, Elizabeth A.;Bian, Jiang;Smith, Steven M.;Guo, Jingchuan
先前的研究表明，心脏保护新药(GLD)的摄取存在差异，包括钠-葡萄糖共转运体-2抑制剂(SGLT2i)和胰高血糖素样肽-1受体激动剂(GLP1a)。这项研究旨在描述较新的GLDs的启动过程中的地理差异以及这些药物启动过程中的地理差异。使用2017年至2018年联邦医疗保险D部分受益人全国随机抽样的15%索赔数据，我们确定了被诊断为2型糖尿病(T2D)的个人，他们有≥1GLD处方，并且在索引日期1/1/2018年1月1日之前的一年中没有使用SGLT2i或GLP1a。对患者进行了一年的随访。该队列在时空上与达特茅斯医院转诊区域(HRR)相关联，每个患者被分配到306个HRR中的一个。我们用多变量Poisson回归来估计调整后的起始率，用多变量Logistic回归来评估每个HRR中的种族差异。在纳入分析的795,469名T2D患者中，平均年龄(SD)为73(10)岁，53.3%为女性，12.2%为非西班牙裔黑人，7.2%在随访一年中开始新的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(启动比率，IRR[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])和亚洲/太平洋岛民(0.94[0.89-0.98])患者发起较新的GLD的可能性较小。在不同的HRR上观察到了显著的地域差异，起始率跨度为2.7%-13.6%。这项研究揭示了在启动较新的GLD方面存在显著的地理差异和种族差异。
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.
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影响因子：
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作者：
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DOI：
10.3122/jabfm.2022.02.210360
发表时间：
2022-03-01
影响因子：
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作者：
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McGuire DK;Shih WJ;Cosentino F;Charbonnel B;Cherney DZI;Dagogo-Jack S;Pratley R;Greenberg M;Wang S;Huyck S;Gantz I;Terra SG;Masiukiewicz U;Cannon CP
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DOI：
10.1001/jamahealthforum.2021.4182
发表时间：
2021-12
期刊：
JAMA health forum
影响因子：
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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
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