(196) Social Vulnerability and Initiation of Pharmacotherapy for Gestational Diabetes in a Medicaid Population

Publication Number: 527

Background: Social environment plays an important and often unrecognized role in disease management. Social health determinants including the Centers for Disease Control and Prevention’s Social Vulnerability Index (SVI) have been associated with individual risk for health disparities and adverse health outcomes. Gestational diabetes mellitus (GDM) is a common complication of pregnancy and decisions to initiate pharmacotherapy may be influenced by social or community factors that impact lifestyle and healthcare utilization. However, few studies have evaluated the role of social vulnerability in GDM management.

Objectives: To examine the association between SVI and GDM pharmacotherapy initiation.

Methods: We identified a retrospective cohort of pregnant women with GDM enrolled in Tennessee Medicaid who delivered between 2007-2019 using claims and pharmacy data linked to vital records and a state hospitalization registry. We defined SVI (range: 0 [low vulnerability] to 100 [high vulnerability]) by residential census tract and categorized into quintiles of SVI in the Medicaid population (Q1 = 0-33, Q2: 34-53, Q3: 54-71, Q4: 72-87, and Q5: 88-100) for descriptive analysis. Pharmacotherapy was defined filling an insulin, glyburide, or metformin prescription after GDM diagnosis. We modeled SVI using restricted cubic splines using multivariable logistic regression, adjusting for covariates, to determine the odds of initiating GDM pharmacotherapy at each observed SVI value, relative to a reference SVI of 50.

Results: Of 33,291 women with GDM, 21.7% initiated pharmacotherapy during pregnancy. Women living in areas with higher SVI tended to be Non-Hispanic Black (Q5: 44% vs. Q1: 10%), have a higher body mass index (Q5: 31.3 kg/m2 (SD 8.7) vs. Q1: 29.8 kg/m2 (SD 8.3)), higher rate of prior cesarean delivery (Q5: 21% vs. Q1: 19% ), higher incidence of chronic hypertension (Q5: 11% vs. Q1: 8% ) and were more likely to be prescribed GDM pharmacotherapy (Q5: 23% vs. Q1: 21% ). In multivariable analysis, relative to the reference, SVI scores above 50 were associated with elevated odds of initiating GDM pharmacotherapy (e.g., odds ratio 1.11 [95% CI 1.02-1.22] for SVI = 80). The association with GDM pharmacotherapy was variable and non-significant for SVI scores below 50, with women living in areas with low SVI values having a non-significantly higher likelihood of initiating GDM pharmacotherapy.

Conclusions: SVI has a complex non-linear association with GDM pharmacotherapy initiation. Social vulnerability factors should be considered for the management of GDM.