Racial Disparities in SGLT2 Inhibitor (SGLT2i) and Glucagon-Like Peptide 1 Receptor Agonist (GLP-1 RA) Use in the US Military Health System (MHS): TH-PO1013

Abstract

Background: Recent studies have indicated racial disparities in the use of SGLT2i and GLP-1 RA, novel diabetes mellitus (DM) therapies that have been shown to reduce chronic kidney disease (CKD) progression and cardiovascular morbidity and mortality. We evaluated whether such disparities exist in the MHS, a universal payer system with fewer barriers to health care access. Methods: We extracted data for 2,989,368 non-pregnant adults in 2019. Diagnoses of type 2 DM and CKD were based on ICD-10 codes, labs, and medications. Adjusted odds ratios (aOR) for medication use were calculated by multivariable logistic regression. Results: The DM population was 180,625 (6.0%), of whom 68,747 (38.1%) had CKD (median age 60 years, 47.2% female; 32.5% White, 17.7% Black, 5.1% Asian/Pacific Islander, 0.5% Native American/Alaska Native [NA/AN], 3.1% Other, 11.4% Unknown, and 29.7% Missing). Use of an SGLT2i or GLP-1 RA was 13.1% and 12.5%, respectively (Table) and was higher in White adults than in other races except NA/AN. After adjustment for age, sex, socioeconomic status, and comorbidities (CKD, hypertension, heart disease, heart failure, obesity), aOR of using either medication was significantly lower in all racial groups except NA/AN compared to White adults. Conclusion: In the MHS, a universal payer system with minimal barriers to access, use of an SGLT2i or GLP-1 RA was significantly lower in most non-White adults. Further investigation may be required to determine the factors behind the prescription differences and possible mitigation strategies. The views expressed in this abstract are those of the authors and do not reflect the official position of the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., the Department of Defense, the Department of Health and Human Services, or the U.S. government. Funding: Other U.S. Government Support - SGLT2i GLP-1 RA Use (%) aOR(95% CI) Use (%) aOR(95% CI) Overall 13.1 n/a 12.5 n/a White 16.4 Reference 13.8 Reference Asian/Pacific Islander 11.9 0.77*(0.72, 0.82) 8.8 0.62*(0.58, 0.67) Black 12.3 0.70*(0.67, 0.73) 11.5 0.76* (0.73, 0.79) Native American/Alaska Native 17.0 1.11 (0.93, 1.31) 13.8 0.99(0.82, 1.19) Other 14.9 0.90* *(0.84, 0.98) 11.7 0.82*(0.76, 0.90 Unknown 9.4 0.75*(0.71, 0.79) 10.6 0.78*(0.74, 0.83) *p < .0001 **p < .01 vs. reference. CI, confidence interval