Abstract 12604: Prescribing Patterns of Cardioprotective Antihyperglycemics Among Medicare Beneficiaries Across United States Counties by their Socioeconomic Disadvantageousness

Abstract

Background: Cardioprotective agents, SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP1RA), improve the outcomes of patients with diabetes, but their cost may lead to inequitable use. We evaluated whether the use of these agents is lower in US counties with larger populations of socioeconomically disadvantaged groups. Methods: For 2018, we merged national prescription data for Medicare Part D prescribers with county-level demographic measures from the AHRQ. We compared the number of beneficiaries receiving cardioprotective antihyperglycemics to those on metformin across US counties (Figure A/B). By county we determined demographics (median age, sex and race), median income, urbanization, and markers of health status, including prevalence of diabetes, obesity, and smoking. In multivariable linear regression with SGLT2i/metformin and GLP1RA/metformin prescriptions as outcomes, we evaluated county factors associated with use of cardioprotective agents. Results: There were 2,983 counties with ≥10 prescribers of metformin. Counties had a median of 155 SGLT2i, 108 GLP1RA, and 2307 metformin-receiving beneficiaries per 100,000 population. There was a large variation in county-level SGLT2i and GLP1RA prescribing relative to number of metformin users (Fig A/B). In analyses that accounted for the sociodemographic characteristics of counties and the prevalence of cardiovascular risk factors, higher % black population, higher median age, higher median income, and urbanization were associated with lower use at the county level of people on SGLT2i and GLP1RA in contrast to metformin (p<0.05) (Fig C/D). Conclusion: There was marked variation by county in the use of new, cardioprotective agents. Urban counties and those with large black populations had fewer beneficiaries receiving cardioprotective antihyperglycemic agents.