Association of Race/Ethnicity, Gender, and Socioeconomic Status With Sodium-Glucose Cotransporter 2 Inhibitor Use Among Patients With Diabetes in the US | Cardiology | JAMA Network Open | JAMA Network
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    1 Comment for this article
    Poverty and Diabetes Treatment
    Jeoffry Gordon, MD, MPH | Family Practice
    Yes Optum gets data, big data (900,000+ patients) and shows how discriminatory quality medical care in the USA can be. Actually this study is grossly distorted. There is a marked underestimate of discrimination because their study population included no Medicaid patients. Corporate commercial medicine likes to behave like they do not exist.
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    Original Investigation
    Health Policy
    April 15, 2021

    Association of Race/Ethnicity, Gender, and Socioeconomic Status With Sodium-Glucose Cotransporter 2 Inhibitor Use Among Patients With Diabetes in the US

    Author Affiliations
    • 1Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
    • 2Center for Cardiovascular Outcomes, Quality, and Evaluative Research, University of Pennsylvania, Philadelphia
    • 3Penn Cardiovascular Center for Health Equity and Social Justice, University of Pennsylvania, Philadelphia
    • 4Leonard Davis Institute of Health Economics at the University of Pennsylvania, Philadelphia
    • 5Renal-Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
    • 6Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
    • 7Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
    • 8Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
    • 9Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
    JAMA Netw Open. 2021;4(4):e216139. doi:10.1001/jamanetworkopen.2021.6139
    Key Points

    Question  Are race/ethnicity, gender, and socioeconomic status associated with use of sodium-glucose cotransporter 2 (SGLT2) inhibitors among patients with type 2 diabetes in the US?

    Findings  In a 5-year cohort study of 934 737 commercially insured US patients with type 2 diabetes, the frequency of SGLT2 inhibitor use increased, but use remained low even among patients with heart failure, kidney disease, and cardiovascular disease. Black race, female gender, and lower household income were associated with lower rates of SGLT2 inhibitor use.

    Meaning  In this study, racial/ethnic, gender, and socioeconomic inequities were present in access to SGLT2 inhibitor treatment, which if unaddressed, may widen disparities in kidney and cardiovascular outcomes in the US.


    Importance  Sodium-glucose cotransporter 2 (SGLT2) inhibitors significantly reduce deaths from cardiovascular conditions, hospitalizations for heart failure, and progression of kidney disease among patients with type 2 diabetes. Black individuals have a disproportionate burden of cardiovascular and chronic kidney disease (CKD). Adoption of novel therapeutics has been slower among Black and female patients and among patients with low socioeconomic status than among White or male patients or patients with higher socioeconomic status.

    Objective  To assess whether inequities based on race/ethnicity, gender, and socioeconomic status exist in SGLT2 inhibitor use among patients with type 2 diabetes in the US.

    Design, Setting, and Participants  This retrospective cohort study of commercially insured patients in the US was performed from October 1, 2015, to June 30, 2019, using the Optum Clinformatics Data Mart. Adult patients with a diagnosis of type 2 diabetes, including those with heart failure with reduced ejection fraction (HFrEF), atherosclerotic cardiovascular disease (ASCVD), or CKD, were evaluated in the analysis.

    Main Outcomes and Measures  Prescription of an SGLT2 inhibitor. Multivariable logistic regression models were used to assess the association of race/ethnicity, gender, and socioeconomic status with SGLT2 inhibitor use.

    Results  Of 934 737 patients with type 2 diabetes (mean [SD] age, 65.4 [12.9] years; 50.7% female; 57.6% White), 81 007 (8.7%) were treated with an SGLT2 inhibitor during the study period. Between 2015 and 2019, the percentage of patients with type 2 diabetes treated with an SGLT2 inhibitor increased from 3.8% to 11.9%. Among patients with type 2 diabetes and cardiovascular or kidney disease, the rate of SGLT2 inhibitor use increased but was lower than that among all patients with type 2 diabetes (HFrEF: 1.9% to 7.6%; ASCVD: 3.0% to 9.8%; CKD: 2.1% to 7.5%). In multivariable analyses, Black race (adjusted odds ratio [aOR], 0.83; 95% CI, 0.81-0.85), Asian race (aOR, 0.94; 95% CI, 0.90-0.98), and female gender (aOR, 0.84; 95% CI, 0.82-0.85) were associated with lower rates of SGLT2 inhibitor use, whereas higher median household income (≥$100 000: aOR, 1.08 [95% CI, 1.05-1.10]; $50 000-$99 999: aOR, 1.05 [95% CI, 1.03-1.07] vs <$50 000) was associated with a higher rate of SGLT2 inhibitor use. These results were similar among patients with HFrEF, ASCVD, and CKD.

    Conclusions and Relevance  In this cohort study, use of an SGLT2 inhibitor treatment increased among patients with type 2 diabetes from 2015 to 2019 but remained low, particularly among patients with HFrEF, CKD, and ASCVD. Black and female patients and patients with low socioeconomic status were less likely to receive an SGLT2 inhibitor, suggesting that interventions to ensure more equitable use are essential to prevent worsening of well-documented disparities in cardiovascular and kidney outcomes in the US.