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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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Listed:
  • Wei-Han Chen
  • Yujia Li
  • Lanting Yang
  • John M Allen
  • Hui Shao
  • William T Donahoo
  • Lori Billelo
  • Xia Hu
  • Elizabeth A Shenkman
  • Jiang Bian
  • Steven M Smith
  • Jingchuan Guo

Abstract

Background: 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. Methods: 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. Results: 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%. Conclusions: This study uncovered substantial geographic variation and the racial disparities in initiating newer GLDs.

Suggested Citation

  • Wei-Han Chen & Yujia Li & Lanting Yang & John M Allen & Hui Shao & William T Donahoo & Lori Billelo & Xia Hu & Elizabeth A Shenkman & Jiang Bian & Steven M Smith & Jingchuan Guo, 2024. "Geographic variation and racial disparities in adoption of newer glucose-lowering drugs with cardiovascular benefits among US Medicare beneficiaries with type 2 diabetes," PLOS ONE, Public Library of Science, vol. 19(1), pages 1-12, January.
  • Handle: RePEc:plo:pone00:0297208
    DOI: 10.1371/journal.pone.0297208
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