A recent study analyzes the factors associated with semaglutide initiation in obese adults without diabetes who have commercial insurance. The research highlights disparities in medication access and identifies key factors influencing treatment decisions.
A recent study published in JAMA Network Open investigated the factors influencing the initiation of semaglutide treatment among obese adults without diabetes who have commercial insurance. The demand for novel GLP-1 receptor agonist medications, such as tirzepatide and semaglutide, has surged. Originally prescribed for type 2 diabetes, these drugs are now FDA-approved for weight management and cardiovascular disease prevention.
Obesity, often disregarded as a treatable condition, poses a significant risk factor for diabetes and cardiometabolic disorders. Despite the availability of effective treatments like GLP-1 receptor agonists, many obese individuals remain undertreated, often relying primarily on lifestyle counseling.In the United States, where a substantial 73.6% of the population is overweight or obese, a considerable number of individuals utilize GLP-1 agonists for weight management without direct medical guidance. However, access to these medications is frequently hindered by insurance coverage disparities, disproportionately affecting populations from lower socioeconomic backgrounds and Black and Hispanic communities. Addressing these inequities is crucial for mitigating the obesity burden.The current study aimed to explore the factors driving semaglutide initiation among obese adults without diabetes and with commercial insurance. Researchers employed a machine learning approach to identify key factors and utilized multivariable regression modeling to quantify the association of these factors with semaglutide initiation. Data was sourced from the Merative MarketScan Commercial Claims and Encounters database, encompassing demographic information, inpatient and outpatient claims, and prescribed medications for insured individuals aged 18 to 64. A cohort was created, including individuals with at least one healthcare encounter for obesity, either inpatient or outpatient. The first claim identifying obesity was utilized as the baseline. Individuals who underwent bariatric surgery, received antihyperglycemic medications, or were pregnant within six months prior to the obesity diagnosis were excluded.The study analyzed a cohort of 97,456 individuals aged 45 to 54, with 50.7% covered by preferred provider organization (PPO) plans. Over 50% of the cohort resided in the Southern region. Approximately 2% of participants received semaglutide prescriptions within six months of their initial obesity diagnosis. Individuals aged 55 to 64 were more likely to receive semaglutide prescriptions compared to those aged 18 to 24. The group with the highest body mass index (BMI) also received a higher proportion of semaglutide prescriptions. An AUROC model identified sex, economic status, age, region, employment status, and insurance plan type as the primary factors associated with semaglutide initiation. Females, older individuals in the Northeast and South, those employed in the service industry, and those with PPO plans were more likely to receive semaglutide prescriptions compared to men. Individuals with unknown employer industries were less likely to initiate semaglutide. Multivariable logistic regression analysis revealed that individuals with more recent index dates had higher odds of initiating semaglutide within six months, peaking in March 2022 and declining through June 2022. Furthermore, individuals residing in the North Central and Northeast regions were more likely to initiate semaglutide compared to those in the West. Participants with employers in non-durable goods manufacturing, insurance, real estate, and finance were also more likely to start semaglutide. Notably, individuals with prescriptions for amphetamine stimulants and antidepressant medications had higher odds of receiving semaglutide.This study employed a novel machine learning approach to identify healthcare, sociodemographic, and clinical factors associated with semaglutide initiation within six months of an obesity diagnosis. The findings highlight existing disparities in medication access among obese individuals. Further research could investigate whether concurrent use of common medications impacts semaglutide's effectiveness and expand the sample to include individuals with public payer plans
Obesity Semaglutide GLP-1 Receptor Agonist Health Inequities Machine Learning Commercial Insurance
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