(G) Impact of Contextual-Level Social Determinants of Health on Novel Antidiabetic Drug Adoption in Patients with Type 2 Diabetes

Sunday, August 28, 2022

8:00 AM – 6:00 PM CEST

Location: Hall E South

Publication Number: 1006

Presenting Author(s)

Yujia Li
– University of Florida, Gainesville, Florida, United States

Co-Author(s)

Hui Hu
– Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, United States
Yi Zheng
– Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, United States
Jie Xu
– Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, United States
Wei-Han Chen, BS
– University of Florida, Gainesville, Florida, United States
Ning Liu
– Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, United States
Jiang Bian
– Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, United States
Serena Jingchuan Guo, MP PhD
– Assistant Professor, University of Florida Department of Pharmaceutical Outcomes and Policy, University of Florida , Gainesville, Florida, United States

Background: Contextual-level social determinants of health (SDoH) have been increasingly recognized as a vital source of information for healthcare policies aiming to place greater emphasis on value-based care. However, major gaps exist in understanding the extent to which contextual-level SDoHs impact access to contemporary treatment in diabetes care. We hypothesized that contextual-level SDoHs may affect access to novel antidiabetic drugs (ADD), that is, sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1a), for patients with type 2 diabetes (T2D).

Objectives: This study aimed to examine the association between contextual-level SDoH and access to SGLT2i/GLP1a, and whether access varies across racial and ethnic groups.

Methods: Using electronic health records from the OneFlorida+ network, we assembled a cohort of T2D patients who initiated a second-line ADD in 2015–2020. The T2D cohort was spatiotemporally linked to a set of 131 contextual SDoHs documenting their social and built environment at the census tract level. We applied an exposome-wide association approach to identify key contextual-level SDoHs associated with initiation of SGTL2i/GLP1a versus other second-line ADDs and multilevel logistic regression to determine their effect across racial groups, adjusting for clinical factors.

Results: Of 28,874 study patients, 61% were women, 36% were non-Hispanic Black, and the mean age was 58 (± 15) years. Two contextual SDoH factors identified as significantly associated with SGLT2i/GLP1a use were the neighborhood deprivation index and percent of vacant addresses in the neighborhood. Patients living in such neighborhoods are less likely to be prescribed newer ADDs. There was no interrelation between race/ethnicity and SDoH with regard to the use of newer ADDs.

Conclusions: Using a data-driven approach, we determined the key contextual-level SDoH factors associated with evidence-based treatment of T2D. Our findings yielded data on social and built environments that contribute to disparities in access to T2D treatment. Further investigations are needed to examine the mechanisms underlying these associations.