Abstract 4145988: Individual- and Community-level Socioeconomic Differences in Use of GLP-1 Receptor Agonists in Diabetes

Introduction: Cardiovascular-kidney-metabolic (CKM) syndrome disproportionately affects individuals with adverse social determinants of health (SDOH). While glucagon-like peptide-1 receptor agonists (GLP-1RAs) improve outcomes in CKM syndrome, inequitable access (e.g., coverage, supply constraints) may worsen health disparities in CKM syndrome. Aims: To characterize the association of individual- and community-level SDOH with GLP-1RA use among Medicare beneficiaries with diabetes. Methods: Cross-sectional study using 100% Medicare claims linked with the Social Vulnerability Index and the US Department of Agriculture Rural-Urban Commuting Area Codes. We evaluated Medicare Advantage and fee-for-service beneficiaries ≥65 years with diabetes enrolled in Part D in 2021 (last year available). Filled prescriptions for GLP-1RAs were identified using National Drug Codes. Baseline characteristics were compared using standardized mean differences. Associations between SDOH (self-identified race and ethnicity, insurance status, social vulnerability index, median household income, rurality, US census region) and GLP-1RA use was evaluated using multivariate logistic regression adjusted for age, sex, and clinical characteristics. Results: Of 13,429,963 adults with diabetes included in the analysis, mean age was 77y and 54.6% were female. During the 1-year study period, 8.5% (475,719) filled ≥1 GLP-1RA prescriptions and were more likely to be younger, have obesity and chronic kidney disease. After adjustment, race and ethnicity were associated with GLP-1 RA use (Compared with non-Hispanic pregnancy: Black race, OR 0.74 (95% CI: 0.73– 0.75); Asian American race, OR 0.80 (0.78– 0.81); Native American, OR, 1.56 (1.50 –1.62); and Hispanic ethnicity 0.91 (0.89–0.93). Medicare Advantage enrollees had lower odds of use than fee-for-service Medicare: OR, 1.18 (1.17 – 1.19). Dual enrollee status, higher median household income, rurality, and higher social vulnerability were associated with greater use. Conclusions: There is substantial variability in the use of GLP-1RAs by individual-level and community-level SDOH factors. Determining the drivers of differential access is urgently needed to enhance equitable use.