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

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Listed:
  • 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
    Department of Medicine, Harvard Medical School, Boston, MA 02115, USA)

  • Yi Zheng

    (Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
    Department of Medicine, Harvard Medical School, 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)

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.

Suggested Citation

  • Yujia Li & Hui Hu & Yi Zheng & William Troy Donahoo & Yi Guo & Jie Xu & Wei-Han Chen & Ning Liu & Elisabeth A. Shenkman & Jiang Bian & Jingchuan Guo, 2023. "Impact of Contextual-Level Social Determinants of Health on Newer Antidiabetic Drug Adoption in Patients with Type 2 Diabetes," IJERPH, MDPI, vol. 20(5), pages 1-14, February.
    • Handle: RePEc:gam:jijerp:v:20:y:2023:i:5:p:4036-:d:1078989
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    References listed on IDEAS

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    1. Rupasingha, Anil & Goetz, Stephan J. & Freshwater, David, 2006. "The production of social capital in US counties," Journal of Behavioral and Experimental Economics (formerly The Journal of Socio-Economics), Elsevier, vol. 35(1), pages 83-101, February.
    2. Macarius M. Donneyong & Teng-Jen Chang & John W. Jackson & Michael A. Langston & Paul D. Juarez & Shawnita Sealy-Jefferson & Bo Lu & Wansoo Im & R. Burciaga Valdez & Baldwin M. Way & Cynthia Colen & M, 2020. "Structural and Social Determinants of Health Factors Associated with County-Level Variation in Non-Adherence to Antihypertensive Medication Treatment," IJERPH, MDPI, vol. 17(18), pages 1-12, September.
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