Utilization Rates of SGLT2 Inhibitors and GLP-1 Receptor Agonists and Their Facility-Level Variation Among Patients With Atherosclerotic Cardiovascular Disease and Type 2 Diabetes: Insights From the Department of Veterans Affairs

<i>Objective:</i> There is mounting evidence regarding the cardiovascular (CV) benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2-Is) and glucagon like peptide-1 receptor agonists (GLP-1RAs) among patients with atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes (T2DM). There is paucity of data assessing real-world practice patterns for these drug classes. We aimed to assess utilization rates of these drug classes and facility-level variation in their utilization. <p> </p> <p><i>Research Design and Methods:</i> We used the nationwide Veterans Affairs (VA) healthcare system dataset from January 1, 2020 to December 31, 2020 and included patients with established ASCVD and T2DM. Among these patients, we assessed the use of SGLT2i and GLP-1RA and the facility-level variation in their utilization. Facility-level variation was computed using median rate ratios (MRR), a measure of likelihood that two random facilities differ in use of SGLT2i and GLP-1RA in patients with ASCVD and T2DM. </p> <p> </p> <p><i>Results:</i> Among 537,980 patients with ASCVD and T2DM across 130 VA facilities, 11.2% of patients received SGLT2i while 8.0% of patients received GLP-1RA. Patients receiving these cardioprotective glucose-lowering drug classes were on average younger and had a higher proportion of non-Hispanic Whites. Overall, median (10^th-90^th percentile) facility-level rates were 14.92% (9.31%-22.50%) for SGLT2i and 10.88% (4.44%-17.07%) for GLP-1RA. There was significant facility level variation among SGLT2-Is utilization - MRR_unadjusted (95% CI):1.41 (1.35-1.47) and MRR_adjusted (95% CI): 1.55 (1.46 – 1.63). Similar facility level variation was observed for utilization of GLP-1 RA – MRR_unadjusted (95% CI):1.34 (1.29-1.38) and MRR_adjusted(95% CI): 1.78 (1.65 – 1.90).</p> <p> </p> <p><i>Conclusions:</i> Overall utilization rates of SGLT2i and GLP-1RA among eligible patients are low with significantly higher residual facility-level variation in utilization of these drug classes. Our results suggest opportunities to optimize their use to prevent future adverse cardiovascular events among these patients. </p>

Utilization Rates of SGLT2 Inhibitors and GLP-1 Receptor Agonists and Their Facility-Level Variation Among Patients With Atherosclerotic Cardiovascular Disease and Type 2 Diabetes: Insights From the Department of Veterans Affairs

<i>Objective:</i> There is mounting evidence regarding the cardiovascular (CV) benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2-Is) and glucagon like peptide-1 receptor agonists (GLP-1RAs) among patients with atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes (T2DM). There is paucity of data assessing real-world practice patterns for these drug classes. We aimed to assess utilization rates of these drug classes and facility-level variation in their utilization. <p> </p> <p><i>Research Design and Methods:</i> We used the nationwide Veterans Affairs (VA) healthcare system dataset from January 1, 2020 to December 31, 2020 and included patients with established ASCVD and T2DM. Among these patients, we assessed the use of SGLT2i and GLP-1RA and the facility-level variation in their utilization. Facility-level variation was computed using median rate ratios (MRR), a measure of likelihood that two random facilities differ in use of SGLT2i and GLP-1RA in patients with ASCVD and T2DM. </p> <p> </p> <p><i>Results:</i> Among 537,980 patients with ASCVD and T2DM across 130 VA facilities, 11.2% of patients received SGLT2i while 8.0% of patients received GLP-1RA. Patients receiving these cardioprotective glucose-lowering drug classes were on average younger and had a higher proportion of non-Hispanic Whites. Overall, median (10^th-90^th percentile) facility-level rates were 14.92% (9.31%-22.50%) for SGLT2i and 10.88% (4.44%-17.07%) for GLP-1RA. There was significant facility level variation among SGLT2-Is utilization - MRR_unadjusted (95% CI):1.41 (1.35-1.47) and MRR_adjusted (95% CI): 1.55 (1.46 – 1.63). Similar facility level variation was observed for utilization of GLP-1 RA – MRR_unadjusted (95% CI):1.34 (1.29-1.38) and MRR_adjusted(95% CI): 1.78 (1.65 – 1.90).</p> <p> </p> <p><i>Conclusions:</i> Overall utilization rates of SGLT2i and GLP-1RA among eligible patients are low with significantly higher residual facility-level variation in utilization of these drug classes. Our results suggest opportunities to optimize their use to prevent future adverse cardiovascular events among these patients. </p>

Utilization Rates of SGLT2 Inhibitors and GLP-1 Receptor Agonists and Their Facility-Level Variation Among Patients With Atherosclerotic Cardiovascular Disease and Type 2 Diabetes: Insights From the Department of Veterans Affairs

OBJECTIVE There is mounting evidence regarding the cardiovascular benefits of sodium–glucose cotransporter 2 inhibitors (SGLT2-Is) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) among patients with atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes mellitus (T2DM). There is paucity of data assessing real-world practice patterns for these drug classes. We aimed to assess utilization rates of these drug classes and facility-level variation in their use. RESEARCH DESIGN AND METHODS We used the nationwide Veterans Affairs (VA) health care system data set from 1 January 2020 to 31 December 2020 and included patients with established ASCVD and T2DM. Among these patients, we assessed the use of SGLT2-I and GLP-1 RA and the facility-level variation in their use. Facility-level variation was computed using median rate ratios (MRR), a measure of likelihood that two random facilities differ in use of SGLT2i and GLP-1 RA in patients with ASCVD and T2DM. RESULTS Among 537,980 patients with ASCVD and T2DM across 130 VA facilities, 11.2% of patients received an SGLT2i while 8.0% of patients received a GLP-1 RA. Patients receiving these cardioprotective glucose-lowering drug classes were on average younger and had a higher proportion of non-Hispanic Whites. Overall, median (10th–90th percentile) facility-level rates were 14.92% (9.31–22.50) for SGLT2i and 10.88% (4.44–17.07) for GLP-1 RA. There was significant facility-level variation among SGLT2-Is use—MRRunadjusted: 1.41 (95% CI 1.35–1.47) and MRRadjusted: 1.55 (95% CI 1.46 –1.63). Similar facility-level variation was observed for use of GLP-1 RA—MRRunadjusted: 1.34 (95% CI 1.29–1.38) and MRRadjusted: 1.78 (95% CI1.65–1.90). CONCLUSIONS Overall utilization rates of SGLT2i and GLP-1 RA among eligible patients are low, with significantly higher residual facility-level variation in the use of these drug classes. Our results suggest opportunities to optimize their use to prevent future adverse cardiovascular events among these patients.

Large Individual-Level Variability in Diel Activity and Depth Use for the Common Lionfish (Pterois miles)

The common lionfish, Pterois miles, a notoriously invasive species known for its harmful effect on native fish communities in the Atlantic Ocean, has recently begun spreading across the Mediterranean Sea. The wide niche breadth of the lionfish has been hypothesized to facilitate its invasion success. However, it is unclear to what extent this wide niche-breadth is associated with individual-level variation and repeatable behavior over time. Large individual-level behavioral variations may allow individuals to adapt quickly to local conditions, increasing the species’ chance of invasion success and complicating mitigation efforts. In this study, we used an acoustic telemetry system in P. miles’ native Red Sea environment to explore individual-level variation in depth preference and diel activity. A wide depth range may indicate an ability to tolerate a variety of biotic and abiotic conditions, and variability in diel activity may indicate an ability to exploit multiple diet sources. We found large individual-level variability in P. miles’ activity hours; although all tracked fish were active during both sunrise and sunset, certain individuals had prolonged activity hours to variable extents. Moreover, individuals often change their patterns over time, showing low repeatability. We also found that individuals had different depth preferences and commuted between shallow and deep waters over short periods of time. This study is one of the first to explore diel activity as an individual-level trait in wild fish. The variability found in depth and diel activity is likely one of the reasons P. miles has been so successful in invading the Mediterranean Sea. In addition, this variability may impact mitigation efforts within the Mediterranean Sea as nocturnal individuals from deeper waters might replenish diurnally culled shallow-water populations.

Community multiculturalism and immigrant crime

There is considerable international and local-level variation in immigrant crime. In this article, we propose a theoretical model to better understand that contextual variation. Furthermore, we present the results of our first attempts to empirically assess the validity of the framework, focussing on local-level variation in crime among residents of Turkish or Moroccan origin in the Netherlands. The proposed model connects Berry's acculturation theory to criminological theories, using relevant findings from the immigration acculturation literature as starting points. It theorises that host societies with a ‘multicultural acculturation orientation’ tend to reduce immigrant crime by fostering informal social control and attenuating criminogenic strains. The empirical analyses explore whether local-level variation in multicultural attitudes among the native-Dutch indeed predicts municipal variation in the number of registered suspected crimes among first- and second-generation immigrants, focussing on men of Turkish or Moroccan origin residing in 35 Dutch cities. The empirical analyses are based on a unique database that combines aggregated survey data, which were used to measure natives’ acculturation attitudes, with administrative microdata, including micro-level police data. Evidence is found for a protective effect of local-level multiculturalism for first-generation immigrant crime in particular, especially for immigrant men living in larger local immigrant communities. We also find stronger effects for the more cohesive and societally accepted Turkish-Dutch group than for the more fragmented and excluded Moroccan-Dutch.