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Disparities in Access to Semaglutide and Tirzepatide Due to Race, Diabetes, and Insurance Status
Katherine Wasden
1, Pourya Medhati
2, Vasundhara Mathur
2, Thomas Shin
2, Abdelrahman Nimeri
2, Ali Tavakkoli
2, Eric G Sheu
2
1Harvard Medical School, Boston, MA, 2Brigham and Women's Hospital, Boston, MA
Background: Broadening usage of new anti-obesity medications (AOMs) such as GLP-1 and GLP-1/GIP agonists has led to concerns of disparities in access. We aimed to analyze patient and office visit factors that impacted the AOM prescribed to patients to better understand the factors influencing access.
Methods: Patient demographics, visit characteristics, and AOMs prescribed for all appointments at a large, multi-disciplinary tertiary care medical weight loss clinic in January 2024 were analyzed. Patient median income and Distressed Community Index (DCI) scores (based on patient zip-code) were collected. Univariate and multivariate analyses were performed using R-studio.
Results: We reviewed 952 patients across 956 appointments. Patients were largely White (69.5%), non-Hispanic (78.9%), females (83.3%), and upper middle class (57.6%) with private insurance (84.3%). Average BMI was 35.7 kg/m2 and most patients did not have diabetes (86.4%). Univariate analyses showed significant differences in AOM prescribed based on race (p=0.004), ethnicity (p=0.006), BMI (p<0.001), appointment type (p=0.002), patient income (p=0.02), DCI score (p=0.04), and insurance type (p<0.001). On multivariate analysis, Black patients were 48% less likely to be prescribed Semaglutide or Tirzepatide compared to a different AOM or no medication (OR=0.52, p=0.004), while patients with diabetes (OR 2.153, p=0.001), private insurance (OR 2.641, p <0.001), and established patients (OR=2.201, p<0.001) were more likely to be prescribed Semaglutide or Tirzepatide.
Conclusion: Independent of other factors, patients with type II diabetes, established patients and patients with private insurance were more likely to be prescribed Tirzepatide or Semaglutide, and Black race negatively impacted access to these medications.
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