Racial and ethnic disparities in early uptake of GLP-1 receptor agonists in patients with and without MASLD

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are effective in managing Type 2 diabetes mellitus (T2DM), obesity, and metabolic dysfunction-associated steatotic liver disease (MASLD). While disparities in GLP-1 RA prescriptions exist, little is known about racial and ethnic differences in early initiation, particularly in MASLD patients. This study evaluates racial and ethnic disparities in early GLP-1 RA uptake among eligible patients with and without MASLD Methods: We conducted a retrospective cohort study using the All of Us Research Program (2016–2022), including adults (≥18 years) with T2DM and/or obesity eligible for GLP-1 RA therapy. Early uptake was defined as a prescription within one year of eligibility. Race/ethnicity was categorized as non-Hispanic (NH) White, Black, Hispanic/Latino, Asian, or Other. Multivariable Cox regression models assessed associations between race/ethnicity and early prescription, adjusting for sociodemographic and clinical factors. A sub-analysis examined disparities among MASLD patients. Results: Among 89,019 eligible patients, 1.17% (n=1,039) initiated GLP-1 RA therapy within one year. Black (HR: 0.79, 95%CI: 0.65–0.95, p=0.014) and Hispanic/Latino (HR: 0.66, 95%CI: 0.53–0.82, p<0.001) patients had significantly lower uptake than NH Whites. Among MASLD patients, Asians had significantly higher early uptake (HR: 5.41, 95%CI: 2.2–13.6, p<0.001). Higher BMI, T2DM, and hyperlipidemia predicted early initiation, while older age, male sex, Black, and Hispanic race were associated with lower uptake Conclusion(s) : Significant racial and ethnic disparities exist in early GLP-1 RA uptake. Efforts are needed to promote equitable access and utilization, particularly for high-risk populations