Impact of Contextual-Level Social Determinants of Health on Newer Antidiabetic Drug Adoption in Patients with Type 2 Diabetes

Yujia Li, Hui Hu, Yi Zheng, William Troy Donahoo, Yi Guo, Jie Xu, Wei-Han Chen, Ning Liu, Elisabeth A. Shenkman, Jiang Bian and Jingchuan Guo ()
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Yujia Li: Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
Hui Hu: Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
Yi Zheng: Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
William Troy Donahoo: Division of Endocrinology, Diabetes and Metabolism, College of Medicine, University of Florida, Gainesville, FL 32610, USA
Yi Guo: Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
Jie Xu: Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
Wei-Han Chen: Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
Ning Liu: Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA
Elisabeth A. Shenkman: Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
Jiang Bian: Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA
Jingchuan Guo: Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL 32610, USA

IJERPH, 2023, vol. 20, issue 5, 1-14

Abstract: Background: We aimed to investigate the association between contextual-level social determinants of health (SDoH) and the use of novel antidiabetic drugs (ADD), including sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1a) for patients with type 2 diabetes (T2D), and whether the association 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. A set of 81 contextual-level SDoH documenting social and built environment were spatiotemporally linked to individuals based on their residential histories. We assessed the association between the contextual-level SDoH and initiation of SGTL2i/GLP1a and determined their effects across racial groups, adjusting for clinical factors. Results: Of 28,874 individuals, 61% were women, and the mean age was 58 (±15) years. Two contextual-level SDoH factors identified as significantly associated with SGLT2i/GLP1a use were neighborhood deprivation index (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.81–0.94) and the percent of vacant addresses in the neighborhood (OR 0.91, 95% CI 0.85–0.98). Patients living in such neighborhoods are less likely to be prescribed with newer ADD. There was no interaction between race-ethnicity and SDoH on the use of newer ADD. However, in the overall cohort, the non-Hispanic Black individuals were less likely to use newer ADD than the non-Hispanic White individuals (OR 0.82, 95% CI 0.76–0.88). Conclusion: Using a data-driven approach, we identified the key contextual-level SDoH factors associated with not following evidence-based treatment of T2D. Further investigations are needed to examine the mechanisms underlying these associations.

Keywords: social determinants of health; type 2 diabetes; antidiabetic drugs; neighborhood deprivation index; vacant land (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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