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Utibe R. Essien, MD MPH Profile picture
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Sep 7 • 8 tweets • 9 min read
1/ 🧵 NEW Editorial.

In the latest issue of @JAMA_current, my mentor Michael Fine, Donna Washington and I were invited to discuss a new 📝 on disparities in SGLT2i and GLP1-RA use for diabetes and what it means for the field of #Pharmacoequity research.

jamanetwork.com/journals/jama/… ImageImage
2/ As has been discussed frequently over the last month with the insulin co-pay provisions in the #InflationReductionAct, >37 million people in the US have #diabetes.

Regrettably, underrepresented racial and ethnic groups folks have ⬆️ rates of diabetes.

jamanetwork.com/journals/jama/… Image
3/ Even with the ⬆️ rates of diabetes, Black, Hispanic, and Asian patients in the US have been shown to have lower rates of #diabetes treatment, especially with the newer drugs available such as SGLT2i & GLP1-RAs.

SGLT2: jamanetwork.com/journals/jaman…

GLP1: jamanetwork.com/journals/jama-… ImageImage
4/ And so @jlampre & team wanted to see if similar disparities exist in VA.

TL;DR: Patients of several different racial groups & those of Hispanic ethnicity had ⬇️ odds of receiving SGLT2i & GLP1-RA therapies.

jamanetwork.com/journals/jama/…

@Peralta_KHRC @Ndichu_Muiru @LTummalapalli Image
5/ We note that “to truly achieve #Pharmacoequity, we need 3rd-generation research that develops, evaluates & implements evidence-based interventions to eliminate disparities and 4th-generation research that directs action against the structural determinants of unequal care...” ImageImage
6/ We also highlight that while the disparities described by @jlampre et al. are key, this is a regrettably common phenomenon:

New 💊 comes out, individuals from communities of color are last in line to receive them.

From diabetes and #AFib to #COVID19.

jamanetwork.com/journals/jama/… Image
7/ My hope is that as we move closer towards achieving #Pharmacoequity, through research like the latest in
JAMA, but especially through policy changes to enhance access, reduce cost, eliminate bias, and improve quality of 💊 care, we can ⬇️ disparities.

jamanetwork.com/journals/jama/… Image
8/8 Finally, the opportunity to write this piece was a true *ikagai* moment.

Hard to imagine that a year from introducing #Pharmacoequity, I would read it in the 1st sentence of a JAMA article. 🙏🏾

Grateful to the village around supporting this work. 👊🏾

jamanetwork.com/journals/jama/… ImageImage

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More from @UREssien

Utibe R. Essien, MD MPH Profile picture
Jul 27
‼️ NEW Paper ‼️

In @JAMANetworkOpen, we found that VA patients with #AFib who experience homelessness had a 21% ⬇️ odds of receiving stroke-preventing anticoagulation (blood thinners).

Here's more on our journey to this #Pharmacoequity paper.

Link: ja.ma/3ODXdss

1/
Previously, if you looked up "homeless & atrial fibrillation" in PubMed, only 5 results came up.

This included a 2003 @JAMAInternalMed study that saw that Ohio Medicaid enrollees had ⬇️ use of warfarin if they had homelessness or inadequate housing.

ja.ma/3PFwj52

2/
We started digging into this in 2019, when 1st author, David Wilson, a PittMed student & Veteran, met with me for a summer research project.

We decided to use our national #AFib cohort to see if there was a relation b/w homelessness & AF treatment.

ja.ma/3ODXdss

3/
Read 12 tweets
Utibe R. Essien, MD MPH Profile picture
Jul 25
1/ 🧵 NEW Paper!

As part of a special issue on 💊 costs & access, we wrote a broad review on “Pursuing #Pharmacoequity - Determinants, Drivers, and Pathways to Progress.

We talk social & health policy, research, patient & prescriber factors. 👇🏾👇🏾

Link: tinyurl.com/nvtamek8 Image
2/ Understanding the multilevel determinants that influence equitable access to medications (and trying to do so in <5000 words (!) was the goal of our review.

With so many factors out there, we know we only began to scratch the surface.

read.dukeupress.edu/jhppl/article/…

#Pharmacoequity Image
3/ A few topics we discussed:

🔴 Public transportation & geographic access to pharmacies

🔴 Income and wealth inequities

🔴 Research representation

🔴 Health insurance coverage (e.g., ACA & Medicare Part D)

🔴 Clinician bias & trustworthiness

🔴 Patient primary language
Read 6 tweets
Utibe R. Essien, MD MPH Profile picture
Feb 10
1/ 🧵 Out today in @Health_Affairs.

On #Pharmacoequity and equitable access to novel #COVID19 treatment.

Led by future Dr. @rohankhaz, we dive into the challenges & opportunities in ensuring that patients and communities most affected by the pandemic can get the care they need.
2/ At risk of redundancy, we previously discussed the challenges in achieving #Pharmacoequity, including in the pandemic, noting, “…For example, treatment of patients with #COVID19 has revealed substantial inequities in access to life-saving treatments.”

jamanetwork.com/journals/jama/…
3/ That observation was supported by national CDC data from earlier this year, as well as a recent national analysis of Medicare enrollees that found that Black patients had a 23% ⬇️ odds of receiving monoclonal antibodies when diagnosed with #COVID19.

jamanetwork.com/journals/jama/…
Read 6 tweets
Utibe R. Essien, MD MPH Profile picture
Feb 1
1/🧵 It’s #BlackHistoryMonth.

A time for us to re-learn and re-discover our history.

A history beyond the chapter on Civil Rightsin our high school textbooks.

A history beyond the Emancipation Proclamation and Brown v. Board of Education.

So what are you reading this month? Image
2/ The ship grew larger & more terrifying w. each stroke of the paddle. The smells grew stronger, the sounds louder, crying & wailing from one quarter, low singing from another; the anarchic noise of children given an underbeat by hands drumming on wood.”

nytimes.com/2022/01/28/opi…
3/ One of the best essays I’ve read.

“Locked out of the greatest opportunity for wealth accumulation in history, African Americans who were able to afford homes found themselves consigned to communities where their investments were affected by the FHA.”

theatlantic.com/magazine/archi…
Read 12 tweets
Utibe R. Essien, MD MPH Profile picture
Dec 1, 2021
One of the points we made in our article last month (👇🏾) is that #Pharmacoequity extends beyond prescription drug access to the entire therapeutic cascade. A couple of interesting papers led by @ashwin_nathan & @ACFanaroff on TAVRs and #HealthEquity.

jamanetwork.com/journals/jama/…

1/
@ashwin_nathan @ACFanaroff @SameedKhatana @petegroen @jaygirimd @hmartinjulien @bnallamo In @CircOutcomes, the team examined socioeconomic & geographic factors of hospitals that developed TAVR (newer, less invasive treatment for aortic stenosis) programs and found that hospitals serving wealthier patients were ⬆️ likely to start programs.

2/
ahajournals.org/doi/10.1161/CI…
3/3 A month later, the team showed in @JAMACardio that zip codes with ⬆️ rates of Black & Hispanic patients and those with more socioeconomic disadvantages had ⬇️ rates of TAVR, adjusting for age and clinical conditions.

So much to be done in this space.

jamanetwork.com/journals/jamac…
Read 4 tweets
Utibe R. Essien, MD MPH Profile picture
Oct 22, 2021
1/ NEW: Excited to share our Viewpoint in @JAMA_current: "A Policy Prescription for Reducing Health Disparities -- Achieving Pharmacoequity."

A 🧵 on what #Pharmacoequity is, why it should be a public health & policy priority, and how we can achieve it.

jamanetwork.com/journals/jama/…
2/ Ensuring that all individuals, regardless of race & ethnicity, socioeconomic status, or availability of resources, have access to the highest quality medications required to manage their health needs is paramount. This is what we call #Pharmacoequity.

jamanetwork.com/journals/jama/…
3/ The #COVID19 pandemic has brought health equity to the forefront, especially in how we ensure access to novel therapies, from antivirals like #remdesivir and #molnupiravir to the Covid vaccine...

But inequities in access to novel drugs are much more than a Covid problem. 👇🏾
Read 10 tweets

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