Socioeconomic factors and SGLT2 inhibitor initiation in patients with heart failure-a claims data analysis

BACKGROUND: This study was aimed at analysing the association between socioeconomic factors and SGLT2 inhibitor (SGLT2i) initiation in patients with heart failure. METHODS: In this retrospective analysis, German health insurance claims data from 2022 to 2023 were used, covering more than 2.8 million individuals. Heart failure was defined using ICD-10-GM codes. Area-based socioeconomic data were obtained from the INKAR database. Associations were assessed using a multilevel logistic regression analysis. RESULTS: In 2023, 90,841 individuals were diagnosed with heart failure. After excluding patients with prior SGLT2i use in 2022 and those with missing data, 68,426 SGLT2i-naive individuals were included in the analysis. A higher likelihood of SGLT2i initiation was associated with newly coded heart failure (adjusted odds ratio (aOR): 2.42, 95% CI 2.29-2.56) and new enrolment in a disease management program for coronary artery disease (aOR: 1.89, 95% CI 1.68-2.12). Being a pensioner (aOR: 0.86, 95% CI 0.78-0.93), having family insurance (aOR: 0.79, 95% CI 0.66-0.95), moving (aOR: 0.80, 95% CI 0.67-0.95), being female (aOR: 0.83, 95% CI 0.78-0.87), and older age (aOR: 0.37, 95% CI 0.18-0.76) were negatively associated. At the municipal level, residing in a higher-income tax municipality (aOR: 1.70, 95% CI 1.37-2.09) was positively related to SGLT2i initiation. These associations were adjusted for other socioeconomic factors, comorbidities, and heart failure medications. CONCLUSIONS: Women and individuals living in socioeconomically disadvantaged municipalities were less likely to receive SGLT2i initiation for heart failure.