Health Disparities among People with Diabetes in America and The Relationship of Race, Economic Status, and Ethnicity in Contributing to Health Inequality

Research results show that race, ethnicity, and socio-economic disparity influence the uptake of GLP-1 RA medication among people with diabetes which suggests that they are critical determinants of health.

The issue of diabetes has been a topic for research over a long duration of time. Therefore, research is undertaken to ascertain the relationship between diabetes and genetic factors in individuals. The research also looks at other factors beyond the biological composition of the individual. It assesses whether other factors, including race and other socio-economic factors, play a role in patients with diabetes in the USA. The study cohort is particular and involves those who have diabetes and are diagnosed with type 2 diabetes (T2D). The cohort of respondents is also broken down into ethnicities, including black people and Hispanics. The other element of assessment of the research is the socio-economic element. This is measured by the aspect of insurance of the patients. The age range of the respondents is that of adults. The age, in this case, is those above 18 years. The respondent cohort must have had their results at least twice, which means that they have positive results, thus applying the research objectives. The other element of the respondents is the Glucagon-like peptide-1 receptor agonist (GLP-1RA) use. The GLP-1 RA is one of the prescriptions for patients with diabetes. The gender of the patients was also considered, and this is applied as a yardstick in determining the relationship between diabetes and the gender of the individual.

The results of the research suggest that the Continuous data have medians (IQRs) or means (SDs) reported for each group; categorical data have summaries (total numbers and percentages). The student t-test was used to compare constant variables, while the 2 test was used to compare concrete variables. For each year of the trial, we calculated the percentage of patients that used a GLP-1 RA. In addition to individuals with ASCVD, the research also looked at Asian, Black, and Hispanic patients. The research calculated the median (IQR) 30-day prescription copayment for individuals who had previously filled a GLP-1 RA prescription. Using a filled prescription as the dependent variable, it adopted multivariable logistic regression models to examine the connection between race and ethnicity and GLP-1 RA usage (Eberly et al.). In addition to age, gender, and ethnic background (Asian, Black, Hispanic, White), medical conditions such as hyperlipidemia, coronary artery disease, chronic renal disease, kidney failure, or end-stage renal disease and obesity, as well as high blood pressure, are all factors that contribute to a person’s risk of developing these conditions. Heart failure was the independent variable in the study (HFrEF). There is a 95 percent confidence interval (CI) for the adjusted odds ratio (aOR) estimates. SAS, version 9.4, was used to conduct the statistical analysis (SAS Institute Inc). P-value of .05 were considered statistically significant in all statistical tests.

The association between the various categories of patients suggests low use of GLP-1RAs among patients with type 2 diabetes and other cardiovascular complications. The results also indicate that there was direct insurance for most of the patients, including the fact that the insurance scheme for the individual determined their uptake of the medication. By and large, this suggests a higher uptake disparity on account of the economic availability of the individual, with those within the higher income bracket exhibiting a higher level of uptake of the medication. This is an express indicator that income is directly proportional to people’s health because it determines their access to medication. It is further evident from the results that insurance does not cover all medication needs and hence the disparity.

Regarding race, the results mentioned above suggest structural racism, which has been defined as the differences in the enjoyment services, drugs, and other opportunities within the community. Therefore, race is a barrier to the fulfillment of some health desires, and this inherently translates to the fact that it is a significant contributor to the existing healthy inequities. The results are also indicative of the fact that race and the associated cardiovascular disease are related. This is because statistical representation drawn from comparative research indicates that over the years, there has been a high rise in the number of black people who reports

Cardiovascular complications. The number seems to have reduced for the whites, which bolsters that race plays a critical role in diabetes prevalence. Other marginalized groups, particularly the Hispanics, also seem to confirm these results because there is a higher uptake of the medication among them as race. Higher medicine uptake means a higher occurrence of diabetes within the population.

The impact of the study is that it offers insight into the existing health disparity with a particular interest in the disparity relating to income and race. It results in a directed mitigation strategy specific to the said population. Those, particularly in the poor neighborhoods, seem to be victims of this problem. Access to medication remains a thorny issue that requires redress.

Practice Pearls:

• Structural racism is a critical factor of health inequality among Americans.
• GLP-1 RA remains the main form of treating diabetes, and income plays a crucial role in access to medication.
• Medicare insurance has an extensive reach in Americans as much as it does not fully meet the health care demands of the subscribers. But its reach is extensive.

Eberly LA, Yang L, Essien UR, et al. Racial, ethnic, and socioeconomic inequities in glucagon-like peptide-1 receptor agonist use among patients with diabetes in the US. JAMA Health Forum. Published online December 17, 2021. doi:10.1001/jamahealthforum.2021.4182

 

Njideka Aginam, PharmD Candidate, South College School of Pharmacy