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[Preprint]. 2024 Nov 1:2024.10.28.24316312.
doi: 10.1101/2024.10.28.24316312.

Racial and Ethnic Disparities in Prescribing of GLP-1 Receptor Agonists in the United States: A Retrospective Cohort Analysis

Polina V Kukhareva  1 , Julio C Facelli  1 , Matthew J O'Brien  2 , Ram Gouripeddi  1 , Kensaku Kawamoto  1 , Yue Zhang  3 , Deepika Reddy  4 , Daniel C Malone  5
Affiliations

Racial and Ethnic Disparities in Prescribing of GLP-1 Receptor Agonists in the United States: A Retrospective Cohort Analysis

Polina V Kukhareva et al. medRxiv. .

Abstract

Background: Type 2 diabetes (T2D) represents a major public health burden in the United States, with racial disparities in medication use potentially exacerbating inequities in health outcomes. This study examined racial/ethnic differences in the prescription of high-efficacy glucose-lowering medications for T2D using a large EHR network (TriNetX).

Methods: A retrospective cohort study included adults with uncomplicated T2D (ICD-10: E11.9), categorized as Hispanic or Latino (Hispanic) or non-Hispanic American Indian/Alaska Native (AI/AN), Asian, Black, Native Hawaiian/Pacific Islander (NH/PI), and White. Adjusted odds ratios for GLP-1 receptor agonist medications (tirzepatide, semaglutide, and dulaglutide) prescriptions in 2022-2023 were calculated by race/ethnicity, controlling for age, sex, and Charlson Comorbidity Index.

Findings: Among 57,320 patients included in the analysis, we observed significant racial disparities in the prescribing of GLP-1 medications. Compared to White patients, for tirzepatide, adjusted odds ratios prescriptions were 0.6 (95% CI: 0.4-0.9) for AI/AN, 0.3 (95% CI: 0.3-0.4) for Asian, 0.7 (95% CI: 0.6-0.9) for Black, 0.4 (95% CI: 0.3-0.5) for Hispanic, and 0.4 (95% CI: 0.3-0.6) for NH/PI. For semaglutide, adjusted odds ratios were 0.8 (95% CI: 0.7-0.9) for AI/AN, 0.5 (95% CI: 0.5-0.6) for Asian, 0.8 (95% CI: 0.7-0.9) for Black, 0.6 (95% CI: 0.6-0.7) for Hispanic, and 0.6 (95% CI: 0.5-0.8) for NH/PI. For dulaglutide, adjusted odds ratios were 1.2 (95% CI: 1.0-1.4) for AI/AN, 0.5 (95% CI: 0.4-0.5) for Asian, 1.0 (95% CI: 0.9-1.1) for Black, 0.9 (95% CI: 0.8-1.0) for Hispanic, and 0.5 (95% CI: 0.4-0.6) for NH/PI.

Interpretation: Racial disparities in high-efficacy diabetes medication prescriptions may contribute to unequal health outcomes in T2D, highlighting the need for targeted research and interventions for equitable diabetes care.

Keywords: GLP-1 receptor agonist; electronic health records; health equity; type 2 diabetes.

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Conflict of interest statement

Competing interests Outside of the submitted work during the 36 months prior to publication, KK reports honoraria, consulting, sponsored research, writing assistance, licensing, or co-development in the past three years with Hitachi, Pfizer, RTI International, the University of California at San Francisco, Indiana University, the Regenstrief Foundation, the Korean Society of Medical Informatics, the University of Nebraska, NORC at the University of Chicago, the University of Pennsylvania, Yale University, Elsevier, MD Aware, Custom Clinical Decision Support, and the U.S. Office of the National Coordinator for Health IT (via Security Risk Solutions) in the area of health information technology. KK was also an unpaid board member of the non-profit Health Level Seven International health IT standard development organization, he is an unpaid member of the U.S. Health Information Technology Advisory Committee, and he has helped develop a number of health IT tools which may be commercialized to enable wider impact. None of these relationships have direct relevance to the manuscript but are reported in the interest of full disclosure. Outside of the submitted, RH serves on a Data Safety Monitoring Board for Astellas Pharmaceuticals. Other authors have no conflict of interest to report.

Figures

Figure 1.
Figure 1.. Temporal Trends in Use of Highly Effective Glucose-Lowering Medications
Abbreviations: AI/AN - American Indian or Alaskan Native, Black - Black or African American, Hispanic - Hispanic or Latino, NH/PI - Native Hawaiian or Other Pacific Islander
See this image and copyright information in PMC

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