{"doi":"10.1371/journal.pone.0297208","title":"Geographic variation and racial disparities in adoption of newer glucose-lowering drugs with cardiovascular benefits among US Medicare beneficiaries with type 2 diabetes","abstract":"BACKGROUND: Prior studies have shown disparities in the uptake of cardioprotective newer glucose-lowering drugs (GLDs), including sodium-glucose cotranwsporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1a). This study aimed to characterize geographic variation in the initiation of newer GLDs and the geographic variation in the disparities in initiating these medications. METHODS: Using 2017-2018 claims data from a 15% random nationwide sample of Medicare Part D beneficiaries, we identified individuals diagnosed with type 2 diabetes (T2D), who had ≥1 GLD prescriptions, and did not use SGLT2i or GLP1a in the year prior to the index date,1/1/2018. Patients were followed up for a year. The cohort was spatiotemporally linked to Dartmouth hospital-referral regions (HRRs), with each patient assigned to 1 of 306 HRRs. We performed multivariable Poisson regression to estimate adjusted initiation rates, and multivariable logistic regression to assess racial disparities in each HRR. RESULTS: Among 795,469 individuals with T2D included in the analyses, the mean (SD) age was 73 (10) y, 53.3% were women, 12.2% were non-Hispanic Black, and 7.2% initiated a newer GLD in the follow-up year. In the adjusted model including clinical factors, compared to non-Hispanic White patients, non-Hispanic Black (initiation rate ratio, IRR [95% CI]: 0.66 [0.64-0.68]), American Indian/Alaska Native (0.74 [0.66-0.82]), Hispanic (0.85 [0.82-0.87]), and Asian/Pacific islander (0.94 [0.89-0.98]) patients were less likely to initiate newer GLDs. Significant geographic variation was observed across HRRs, with an initiation rate spanning 2.7%-13.6%. CONCLUSIONS: This study uncovered substantial geographic variation and the racial disparities in initiating newer GLDs.","journal":"PLoS ONE","year":2024,"id":431902,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":15,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9524,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1236180,"name":"Yujia Li","orcid":"0000-0002-5655-5254","position":1,"is_corresponding":false},{"id":1236181,"name":"Lanting Yang","orcid":"0000-0003-0597-9062","position":2,"is_corresponding":false},{"id":818071,"name":"John M. Allen","orcid":"0000-0002-0033-4508","position":3,"is_corresponding":false},{"id":713988,"name":"Hui Shao","orcid":"0000-0002-4088-546X","position":4,"is_corresponding":false},{"id":404842,"name":"William T. Donahoo","orcid":"0000-0002-2126-860X","position":5,"is_corresponding":false},{"id":1236538,"name":"Lori Billelo","orcid":null,"position":6,"is_corresponding":false},{"id":368454,"name":"Xia Hu","orcid":"0000-0003-2234-3226","position":7,"is_corresponding":false},{"id":284551,"name":"Elizabeth Shenkman","orcid":"0000-0003-4903-1804","position":8,"is_corresponding":false},{"id":23318,"name":"Jiang Bian","orcid":"0000-0002-2238-5429","position":9,"is_corresponding":false},{"id":510563,"name":"Steven M. Smith","orcid":"0000-0002-0201-839X","position":10,"is_corresponding":false},{"id":415391,"name":"Jingchuan Guo","orcid":"0000-0001-9799-2592","position":11,"is_corresponding":false},{"id":1083988,"name":"Wei‐Han Chen","orcid":"0000-0001-8545-6127","position":0,"is_corresponding":true}],"reference_count":28,"raw_metadata":null,"created_at":"2026-07-19T01:59:30.747263Z","pmid":"38285682","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}