SGLT2 抑制剂处方的种族差异

IF 3.6 3区医学 Q2 PHARMACOLOGY & PHARMACY

Journal of clinical lipidology Pub Date : 2024-07-01 DOI:10.1016/j.jacl.2024.04.043

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引用次数: 0

摘要

背景/简介钠-葡萄糖共转运体-2 抑制剂（SGLT2i）是一种新型药物疗法，可改善患有心力衰竭和慢性肾病（CKD）的 2 型糖尿病（T2DM）患者的死亡率并减少住院次数。在目标导向性药物治疗中，不同患者种族群体的处方模式各不相同，但尚未对 SGLT2i 的处方模式进行深入研究。我们假设，与当地人口的糖尿病患病率相比，基于种族的 SGLT2i 处方之间存在差异。方法我们对服务于纽约州皇后区和拿骚县地区的诺斯韦尔健康系统中开始使用 SGLT2i 的患者进行了回顾性分析。我们收集了 2018 年至 2023 年期间患者的数据。对这些患者的种族人口统计学进行了研究，并在开始使用这些药物的不同专科（心脏病学、肾脏病学、内分泌学和初级保健提供者）之间进行了比较。结果2018年至2023年期间，诺斯韦尔健康中心地区系统共有11255名患者开始使用SGLT2i。在这些患者中，6031 人（53.6%）为白人，1465 人（13.0%）为黑人，892 人（7.9%）为亚裔。这些结果按开药的专业进一步细分。心脏病专家为 3,765 名患者开始使用 SGLT2i，其中 2,179 人（57.9%）为白人，462 人（12.3%）为黑人，357 人（9.5%）为亚裔。肾脏科医生为 355 名患者开始使用 SGLT2i，其中白人 162 人（占 45.6%），黑人 67 人（占 18.9%），亚裔 43 人（占 12.1%）。内分泌科医生让 3979 名患者开始使用 SGLT2i，其中 1953 名（49.1%）为白人，590 名（14.8%）为黑人，280 名（7.0%）为亚裔。初级医疗服务提供者为 3191 名患者开始使用 SGLT2i，其中 1737 人（54.4%）为白人，346 人（10.8%）为黑人，212 人（6.6%）为亚裔。在该地区的 T2DM 患者中，白人约占 41%，黑人占 20%，亚裔占 18%。此外，黑人和亚洲人（尤其是南亚人）的心血管疾病和慢性肾脏病发病率往往较高。从以上分析可以看出，黑人和亚裔患者的 SGLT2i 处方率低于白人患者。这种差异主要体现在初级保健提供者和心脏病专家身上，但也与所有专科有关。虽然我们的研究强调了不同种族群体处方习惯差异的潜在偏差，但我们的比较并未调整保险、药物可负担性和禁忌率等其他干扰因素。

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Racial Variations in SGLT2 Inhibitor Prescriptions

Background/Synopsis

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are novel pharmacotherapies that improve mortality and reduce hospitalizations for patients with type 2 diabetes mellitus (T2DM) suffering from heart failure and chronic kidney disease (CKD). Prescription patterns vary amongst patient racial groups in goal directed medical therapy, however, this has not been thoroughly examined for SGLT2i.

Objective/Purpose

Here, we investigate the racial differences in SGLT2i prescriptions for diabetic patients. We hypothesize that there are differences between SGLT2i prescriptions based on race, compared to prevalence of diabetes in the local population.

Methods

We performed a retrospective analysis of patients started on SGLT2i in the Northwell Health system serving the Queens and Nassau County regions of New York state. Data was collected on patients from 2018 to 2023. The racial demographics of these patients were examined and compared between various specialties (cardiology, nephrology, endocrinology and primary care providers) that started these medications.

Results

A total of 11,255 patients were started on SGLT2i in the Northwell Health central region system from 2018 to 2023. Of these patients, 6,031 (53.6%) were white, 1,465 (13.0%) were black and 892 (7.9%) were Asian. These results were further subdivided by specialty prescribing the medication. Cardiologists started 3,765 patients on SGLT2i with 2,179 (57.9%) being white, 462 (12.3%) being black and 357 (9.5%) being Asian. Nephrologists started 355 patients on SGLT2i with 162 (45.6%) being white, 67 (18.9%) being black and 43 (12.1%) being Asian. Endocrinologists started 3,979 patients on SGLT2i with 1,953 (49.1%) being white, 590 (14.8%) being black and 280 (7.0%) being Asian. Primary care providers started 3191 patients on SGLT2i with 1737 (54.4%) being white, 346 (10.8%) being black and 212 (6.6%) being Asian.

Conclusions

The Queens and Nassau counties served by the central region of Northwell Health include a diverse population. Out of the T2DM population in this area, approximately 41% is white, 20% is black and 18% is Asian. Additionally, black and Asian (particularly South Asian) populations tend to have increased incidence of cardiovascular disease and CKD. From this analysis, it is evident that black and Asian patients are being prescribed SGLT2i at a lower rate as compared to white patients. This discrepancy is most seen in primary care providers and cardiologists, but pertinent for all specialties. Although our study highlights a potential underlying bias in differences in prescriber habits across racial groups, our comparison does not adjust for other confounding factors such as insurance, drug affordability, and contraindication rates.

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来源期刊

Journal of clinical lipidology 医学-药学

CiteScore

7.00

自引率

6.80%

发文量

209

审稿时长

49 days

期刊介绍： Because the scope of clinical lipidology is broad, the topics addressed by the Journal are equally diverse. Typical articles explore lipidology as it is practiced in the treatment setting, recent developments in pharmacological research, reports of treatment and trials, case studies, the impact of lifestyle modification, and similar academic material of interest to the practitioner. While preference is given to material of immediate practical concern, the science that underpins lipidology is forwarded by expert contributors so that evidence-based approaches to reducing cardiovascular and coronary heart disease can be made immediately available to our readers. Sections of the Journal will address pioneering studies and the clinicians who conduct them, case studies, ethical standards and conduct, professional guidance such as ATP and NCEP, editorial commentary, letters from readers, National Lipid Association (NLA) news and upcoming event information, as well as abstracts from the NLA annual scientific sessions and the scientific forums held by its chapters, when appropriate.