Socioeconomic Factors and Initiation of Semaglutide or Tirzepatide Among Medicare Beneficiaries With Type 2 Diabetes

OBJECTIVE Identifying social and economic factors associated with initiation of semaglutide or tirzepatide may inform strategies to support equitable uptake. RESEARCH DESIGN AND METHODS A cross-sectional study was conducted using 100% of Medicare claims of patients ≥65 years with type 2 diabetes mellitus (T2DM). The outcome was initiation of semaglutide or tirzepatide. We calculated adjusted odds ratios (aORs) for each exposure (self-reported race/ethnicity, dual enrollment in Medicare and Medicaid, rurality, and social vulnerability index), accounting for demographic and clinical characteristics. RESULTS Among 13,922,387 patients with T2DM, 673,776 (4.8%) initiated semaglutide or tirzepatide in 2023. Minoritized racial/ethnic identity (e.g., non-Hispanic Black compared with White; aOR 0.72; 95% CI 0.71–0.72), dual enrollment (aOR 0.90; 0.89–0.91), and residence in the most versus least vulnerable socially vulnerable neighborhoods (aOR 0.93; 0.92–0.93) were associated with lower initiation. CONCLUSIONS Minoritized racial/ethnic identity and adverse socioeconomic factors were associated with lower odds of initiation among Medicare beneficiaries with T2DM.