The association of socioeconomic disadvantage and remoteness with receipt of type 2 diabetes medications in Australia: a
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ARTICLE
The association of socioeconomic disadvantage and remoteness with receipt of type 2 diabetes medications in Australia: a nationwide registry study Jedidiah I. Morton 1,2
&
Jenni IlomÓ“ki 2,3
&
Dianna J. Magliano 1,2
&
Jonathan E. Shaw 1,2
Received: 6 August 2020 / Accepted: 9 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Aims/hypothesis In recent years, several new medications for the treatment of type 2 diabetes have been released and some evidence indicates sociodemographic disparity in their utilisation. We sought to investigate sociodemographic disparities in receipt of diabetes medications across Australia. Methods This study included 1,203,317 people with type 2 diabetes registered on the Australian National Diabetes Services Scheme (NDSS) followed from 2007 to 2015. The NDSS was linked to the Australian pharmaceutical claims database. We investigated trends in diabetes medication dispensing and variation in dispensing by sociodemographic strata. Results Compared with individuals in the least disadvantaged areas, those in the most disadvantaged quintile were less likely to receive dipeptidyl peptidase-4 inhibitors (DPP4is), glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium–glucose cotransporter 2 inhibitors (SGLT2is) in the first year of availability (OR [95% CI] for most vs least disadvantaged: 0.78 [0.75, 0.82], 0.65 [0.60, 0.71] and 0.89 [0.84, 0.95], respectively). These disparities dissipated over time for DPP4is and SGLT2is but remained significant for GLP-1RAs. The OR (95% CI) of receiving DPP4is, GLP-1RAs and SGLT2is in the first year of availability for people in remote areas vs major cities was 0.46 (0.39, 0.54), 0.46 (0.35, 0.61) and 0.71 (0.59, 0.84), respectively. These disparities remained significant through to 2015. Conclusions/interpretation People with diabetes in more disadvantaged areas are less likely to receive newer diabetes medications, although this effect decreased over time. However, there are considerable and persistent differences in receipt of newer diabetes medications between major cities and remote areas of Australia.
Keywords Australia . Diabetes . DPP4 inhibitors . GLP-1RAs . Health services research . Medications . Pharmacoepidemiology . SGLT2 inhibitors . Socioeconomic status
Dianna J. Magliano and Jonathan E. Shaw are joint senior authors. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00125-020-05304-3) contains peer-reviewed but unedited supplementary material, which is available to authorised users. * Jedidiah I. Morton [email protected] 1
Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
2
School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
3
Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
Abbreviations ARIA Accessibility and Remoteness Index of Australia ARS Australian Statistical Geography Standard
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