Racial discrepancies found in SGLT2, GLP-1 drug prescriptions in VA health system
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Prescription rates of SGLT2 inhibitors and GLP-1 receptor agonists among adults with type 2 diabetes in the Veterans Health Administration varied by race, with white patients most likely to receive these medications.
The findings, published in JAMA, also showed that prescription rates of these medications were low overall.
Julio A. Lamprea-Montealegre, MD, MPH, PhD, a clinical instructor in the division of cardiology and a postdoctoral research fellow at the Kidney Health Research Collaborative at the University of California, San Francisco, and colleagues performed a cross-sectional analysis using data from the Veterans Affairs Corporate Data Warehouse. They included adult patients with type 2 diabetes and at least two primary care clinic visits in 2019 and 2020.
Prevalent prescriptions of SGLT2 inhibitors or GLP-1 receptor agonists — defined as any active prescription during the study period — served as the primary outcome.
The study included 1,197,914 patients (mean age, 68 years; 96% men) with the following racial/ethnic background: 1% American Indian or Alaska Native; 2% Asian, Native Hawaiian or other Pacific Islander; 20% Black or African American; 71% white; and 7% Hispanic or Latino.
White patients more likely to receive prescriptions
Among patients, 10.7% were prescribed SGLT2 inhibitors and 7.7% GLP-1 receptor agonists. Prescription rates of SGLT2 inhibitors and GLP-1 receptor agonists for the patient groups were as follows:
SGLT2 inhibitors: American Indian or Alaska Native, 11%; Asian, Native Hawaiian or other Pacific Islander, 11.8%; Black or African American, 8.8%; white, 11.3%; Hispanic or Latino, 11%; and non-Hispanic or Latino, 10.7%;
GLP-1 receptor agonists: American Indian or Alaska Native, 8.4%; Asian, Native Hawaiian or other Pacific Islander, 8%; Black or African American, 6.1%; white, 8.2%; Hispanic or Latino, 7.1%; and non-Hispanic or Latino, 7.8%.
Compared with white patients, all other ethnic groups had significantly decreased odds of SGLT2 inhibitors and GLP-1 receptor agonists prescriptions after accounting for patient- and system-level factors.
In addition, black patients had the lowest odds of prescription compared with white patients — adjusted OR = 0.72 (95% CI, 0.71-0.74) for SGLT2 inhibitors and 0.64 (95% CI, 0.63-0.66) for GLP-1 receptor agonists — while Hispanic or Latino patients had lower odds of prescription compared with non-Hispanic or non-Latino patients — aOR = 0.9 (95% CI, 0.88-0.93) for SGLT2 inhibitors and 0.88 (95% CI, 0.85-0.91) for GLP-1 receptor agonists.
The researchers noted that further research is necessary to understand the mechanisms underlying the differences in rates of prescribing observed in the study and the potential relationships with differences in clinical outcomes.
Pharmacoequity will require ‘major shift’
In an accompanying editorial, Utibe R. Essien, MD, MPH, assistant professor of medicine at the University of Pittsburgh School of Medicine and core investigator in the Center for Health Equity and Research Promotion at the VA Pittsburgh Healthcare System, and colleagues wrote that as novel, effective and often costly drugs are approved for use and incorporated into clinical practice guidelines, a disturbing pattern of care is evident: Uptake and diffusion of recommended, evidence-based therapies increase over time, whereas individuals from underrepresented racial and ethnic groups receive these medications less often.
“This phenomenon, demonstrated across myriad clinical conditions and therapeutic classes, results in persistent disparities in access to high-quality medications, likely having a critical role in the disparate health seen in underrepresented racial and ethnic groups in the U.S.,” Essien and colleagues wrote. “Achieving pharmacoequity will require a major shift in rapidly moving the research continuum from detecting and understanding the root causes of treatment disparities to developing and implementing multilevel evidence-based strategies to eliminate them. Along with research, prioritizing equity across the therapeutic continuum, from drug development and trials to prescription drug payment policy and clinical practice, will ensure that all patients receive the highest quality of medication care in the Veterans Health Administration and beyond.”
Reference:
- Essien UR, et al. JAMA. 2022;doi:10.1001/jama.2022.13366.
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