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Social Vulnerability and Initiation of Pharmacotherapy for Gestational Diabetes Mellitus in a Medicaid Population

Published:January 19, 2023DOI:https://doi.org/10.1016/j.whi.2022.12.004

      Abstract

      Objective

      Our study examines the association between social vulnerability index (SVI) and pharmacotherapy initiation for gestational diabetes mellitus (GDM).

      Methods

      We studied a retrospective cohort of pregnant patients with GDM, enrolled in Tennessee Medicaid, who gave birth between 2007 and 2019. Enrollment files were linked to birth and death certificates, state hospitalization registries, and pharmacy claims. SVI, measured at the community level and determined by residential census tract, ranged from 0 to 100 (low to high vulnerability). Multivariable logistic regression assessed the association between SVI and the odds of initiating the most common pharmacotherapies for GDM—insulin, glyburide, or metformin—and adjusted for relevant covariates. SVI was modeled with restricted cubic splines to account for nonlinear associations, using the median Tennessee SVI as a reference. Secondary analysis assessed associations with the SVI subthemes.

      Results

      Among 33,291 patients with GDM, 21.7% (7,209) initiated pharmacotherapy during pregnancy. Patients from areas with higher SVI were more likely to be non-Hispanic Black with higher body mass index, whereas those with lower SVI were more likely to be nulliparous. Multivariable modeling demonstrated a complex nonlinear association between SVI and GDM pharmacotherapy initiation, relative to the reference. Higher SVI was associated with elevated odds of GDM pharmacotherapy initiation (e.g., odds ratio 1.11 [95% confidence interval 1.02–1.22] for SVI 80) and low to medium SVI had variable nonsignificant associations with GDM pharmacotherapy initiation, relative to the reference (lower odds of initiation for values 25–50, higher odds of initiation for values < 25). Secondary analysis demonstrated a nonlinear association between subtheme 3 and the odds of GDM pharmacotherapy initiation.

      Conclusion

      Social vulnerability is associated with initiation of pharmacotherapy for GDM, highlighting the possible role of social determinants of health in achieving glycemic control.
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      Biography

      Amelie Pham, MD, is a Clinical Fellow in the Division of Maternal Fetal Medicine, Vanderbilt University Medical Center, researching the safety of medications in pregnancy.

      Biography

      Andrew Weise, PhD, MPH, is an Assistant Professor in the Department of Health Policy, Vanderbilt University Medical Center, researching the safety of medications in pregnancy.

      Biography

      Andrew Spieker, PhD, is an Assistant Professor in the Department of Biostatistics, Vanderbilt University Medical Center, researching the safety of medications in pregnancy.

      Biography

      Sharon Phillips, MSPH, is an Associate in the Department of Biostatistics, Vanderbilt University Medical Center, researching the safety of medications in pregnancy.

      Biography

      Margaret Adgent, PhD, MSPH, is an Assistant Professor in the Department of Health Policy, Vanderbilt University Medical Center, researching the safety of medications in pregnancy.

      Biography

      Carlos Grijalva, MD, MPH, is an Associate Professor in the Department of Health Policy, Vanderbilt University Medical Center, researching the safety of medications in pregnancy.

      Biography

      Sarah Osmundson, MD, MS, is an Associate Professor in the Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, researching the safety of medications in pregnancy.