Predictors, Disparities, and Facility-Level Variation: SGLT2 Inhibitor Prescription Among US Veterans With CKD

Gregg, L. Parker; Ramsey, David J.; Akeroyd, Julia M.; Jafry, Shehrezade A.; Matheny, Michael E.; Virani, Salim S.; Navaneethan, Sankar D.

doi:10.1053/j.ajkd.2022.11.017

Cited by 13 publications

(11 citation statements)

References 21 publications

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“…We should monitor for the potential of unintended consequences that may lead to systematically underestimating risk in disenfranchised groups who may already be less likely to be appropriately prescribed evidence-based medications (eg, statins, novel glucose-lowering drugs) to reduce CVD risk. [154][155][156] Therefore, calibration of PREVENT across key sociodemographic subgroups (eg, race and ethnicity, strata of social deprivation index) was carefully assessed and demonstrated good calibration among Black individuals (base PREVENT equations calibration slope 1.11 [0.79-1.24]).…”

Section: Removal Of Race From Cvd Risk Prediction Equationsmentioning

confidence: 99%

Novel Prediction Equations for Absolute Risk Assessment of Total Cardiovascular Disease Incorporating Cardiovascular-Kidney-Metabolic Health: A Scientific Statement From the American Heart Association

Khan,

Coresh,

Pencina

et al. 2023

Circulation

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Cardiovascular-kidney-metabolic (CKM) syndrome is a novel construct recently defined by the American Heart Association in response to the high prevalence of metabolic and kidney disease. Epidemiological data demonstrate higher absolute risk of both atherosclerotic cardiovascular disease (CVD) and heart failure as an individual progresses from CKM stage 0 to stage 3, but optimal strategies for risk assessment need to be refined. Absolute risk assessment with the goal to match type and intensity of interventions with predicted risk and expected treatment benefit remains the cornerstone of primary prevention. Given the growing number of therapies in our armamentarium that simultaneously address all 3 CKM axes, novel risk prediction equations are needed that incorporate predictors and outcomes relevant to the CKM context. This should also include social determinants of health, which are key upstream drivers of CVD, to more equitably estimate and address risk. This scientific statement summarizes the background, rationale, and clinical implications for the newly developed sex-specific, race-free risk equations: PREVENT (AHA Predicting Risk of CVD Events). The PREVENT equations enable 10- and 30-year risk estimates for total CVD (composite of atherosclerotic CVD and heart failure), include estimated glomerular filtration rate as a predictor, and adjust for competing risk of non-CVD death among adults 30 to 79 years of age. Additional models accommodate enhanced predictive utility with the addition of CKM factors when clinically indicated for measurement (urine albumin-to-creatinine ratio and hemoglobin A1c) or social determinants of health (social deprivation index) when available. Approaches to implement risk-based prevention using PREVENT across various settings are discussed.

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Section: Removal Of Race From Cvd Risk Prediction Equationsmentioning

confidence: 99%

Novel Prediction Equations for Absolute Risk Assessment of Total Cardiovascular Disease Incorporating Cardiovascular-Kidney-Metabolic Health: A Scientific Statement From the American Heart Association

Khan,

Coresh,

Pencina

et al. 2023

Circulation

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“…Many of these studies have revealed disparities in the uptake of these drugs in the US. Sociodemographic disparities, especially along race/ethnicity, have been documented in multiple subpopulations including Medicare patients, 13,14 veterans, 15,16 older adults, 13,17,18 and patients with comorbid cardiovascular disease (CVD) 13,18 and chronic kidney disease (CKD). 13 Low socioeconomic status has also been associated with worse access to these drugs, independent of insurance status, potentially due to the impact of high copays or deductibles.…”

Section: Introductionmentioning

confidence: 99%

Sociodemographic disparities in the use of GLP-1 receptor agonists and SGLT-2 inhibitors among US adults with type 2 diabetes: NHANES 2005-March 2020

Payne

et al. 2023

Preprint

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Aim: Type 2 Diabetes (T2D) is a major cause of morbidity and mortality. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT-2i) are highly effective but underutilized. We assessed racial/ethnic and other sociodemographic disparities in GLP-1/SGLT-2 use among US adults with T2D. Materials and Methods: We conducted a retrospective analysis using nationally representative data from National Health and Nutrition Examination Survey 2005-March 2020. Participants were adults with T2D taking ≥1 diabetes medication, excluding pregnant women and adults with probable T1D. We performed univariate analyses to examine characteristics of patients using GLP-1/SGLT-2 and multivariable logistic regression to assess disparities in GLP-1/SGLT-2 use after adjusting for other patient factors. Results: Among 4,585 T2D patients (representing >18 million US adults) taking ≥1 medication, GLP-1/SGLT-2 usage increased from 1.4% in 2005-2006 to 13.3% in 2017-2020. In univariate analyses, patients using GLP-1/SGLT-2 vs. other T2D drugs were more likely to be white than nonwhite (72% vs. 60%, p = .001), but in multivariable analysis there was no significant difference in GLP-1/SGLT-2 use for nonwhite vs. white patients (aOR = 0.84, 95% CI [0.61, 1.16]). GLP-1/SGLT-2 use was higher for patients who completed some college (aOR = 1.83, 95% CI [1.06, 3.15]) or above (aOR = 2.06, 95% CI [1.28, 3.32]) vs. high school or less, and for those with an income-poverty ratio ≥4 vs. <2 (aOR = 2.11, 95% CI [1.30, 3.42]). Conclusions: Use of GLP-1/SGLT-2 drugs increased over time but remained low in March 2020. Higher education and income, but not race/ethnicity, were associated with GLP-1/SGLT-2 use.

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“…3 We identified adult patients with comorbid CKD, type 2 diabetes, and atherosclerotic cardiovascular disease using data from the Veterans Affairs (VA) Corporate Data Warehouse, reflecting real-world health care at 130 VA facilities and their affiliated outpatient clinics across the United States. 4 We included individuals with an in-person or telehealth visit (index visit) with a primary care provider (PCP) between January 1, 2020, andDecember 31, 2020. Patients with an eGFR ,60 ml/min per 1.73 m 2 were considered to have CKD. Type 2 diabetes was defined by diagnosis codes, laboratory values, and medications as has been previously described.…”

mentioning

confidence: 99%

“…Type 2 diabetes was defined by diagnosis codes, laboratory values, and medications as has been previously described. 4 Patients with type 1 diabetes were excluded. Atherosclerotic cardiovascular disease was ascertained using diagnosis, procedure, and Current Procedural Terminology codes for ischemic heart disease, ischemic cerebrovascular disease, or peripheral arterial disease.…”

mentioning

confidence: 99%

“…Atherosclerotic cardiovascular disease was ascertained using diagnosis, procedure, and Current Procedural Terminology codes for ischemic heart disease, ischemic cerebrovascular disease, or peripheral arterial disease. 4 GLP-1 RA exposure was defined as a VA or documented non-VA prescription for dulaglutide, exenatide, liraglutide, lixisenatide, or semaglutide within 180 days before or 100 days after the index visit.…”

mentioning

confidence: 99%

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Racial and Ethnic Disparities and Facility-Level Variation in GLP-1 RA Prescription among US Veterans with CKD

Gregg,

Worsley,

Ramsey

et al. 2023

CJASN

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Predictors, Disparities, and Facility-Level Variation: SGLT2 Inhibitor Prescription Among US Veterans With CKD

Cited by 13 publications

References 21 publications

Novel Prediction Equations for Absolute Risk Assessment of Total Cardiovascular Disease Incorporating Cardiovascular-Kidney-Metabolic Health: A Scientific Statement From the American Heart Association

Novel Prediction Equations for Absolute Risk Assessment of Total Cardiovascular Disease Incorporating Cardiovascular-Kidney-Metabolic Health: A Scientific Statement From the American Heart Association

Sociodemographic disparities in the use of GLP-1 receptor agonists and SGLT-2 inhibitors among US adults with type 2 diabetes: NHANES 2005-March 2020

Racial and Ethnic Disparities and Facility-Level Variation in GLP-1 RA Prescription among US Veterans with CKD

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