Breaking Barriers: Tackling Racial and Socioeconomic Disparities in the Prescription of Life-Saving SGLT2 Inhibitors for Proteinuria

Introduction: The underutilization of sodium-glucose co-transporter type 2 inhibitors (SGLT2i), despite their proven cardiovascular and renal benefits, raises concerns about healthcare equity. SGLT2i effectively reduces proteinuria, a key indicator of kidney disease, making them an essential treatment for individuals with or without diabetes, particularly those at higher risk, such as the Black American population, who have a higher prevalence of proteinuria. However, studies show disparities in SGLT2i prescriptions with race, ethnicity, and socioeconomic status contributing to lower utilization rates among vulnerable populations. This study aims to explore SGLT2i prescription patterns in Maryland, focusing on patients with proteinuria to address these disparities and improve access to care. Objective: The objective of the study was to identify racial and socioeconomic disparities in access to SGLT2i. Methods: This retrospective cohort study utilized de-identified electronic health records (EHR) sourced from the Epic database across the University of Maryland Medical System (UMMS), spanning a 10-year period from January 1, 2014, to December 31, 2023, and evaluated SGLT2i prescription patterns among patients with proteinuria. Result: Of the 5,866,616 patients in the UMMS system, 28,136 were diagnosed with proteinuria, of whom 4,360 (15.5%) were prescribed SGLT2i medications. Among those receiving prescriptions, 37.9% self-identified as Black American, while 54.7% identified as White American. Notable geographical disparities were observed in prescription rates. In affluent areas such as Fulton, MD (zip code 20759), only 0.046% of patients with proteinuria received SGLT2i prescriptions, compared to 1.4% in the lower-income area of West Baltimore, MD (zip code 21223). Bivariate analysis revealed significant disparities in SGLT2i prescription rates, with Black American patients having lower odds of receiving prescriptions compared to White American patients (OR = 0.68, p < 0.001) and affluent areas like Fulton showing significantly lower odds compared to lower-income areas like West Baltimore (OR = 0.31, p < 0.001). These disparities persisted in multivariate analysis, where Black American patients had adjusted PR (AOR) of 0.72 (p = 0.002) relative to White American patients, and West Baltimore residents had higher odds (AOR = 1.72, p = 0.01) compared to significantly reduced odds in Fulton (AOR = 0.35, p = 0.02). Conclusion: This study reveals significant disparities in the prescription of SGLT2i among patients with proteinuria in Maryland, United States, highlighting the influence of socioeconomic factors on access to these vital treatments. Despite the established benefits of SGLT2i in managing proteinuria and reducing the risk of kidney and cardiovascular disease, systemic inequities persist, potentially leaving high-risk populations underserved. These findings call for a deeper examination of the structural and systemic barriers contributing to these disparities, as well as the development of strategies to promote equitable access to care. Ensuring that all patients, regardless of their background or socioeconomic status, have access to evidence-based therapies is essential for improving outcomes and reducing healthcare inequities.