Socioeconomic and Demographic Inequalities in Off-Label Prescription of Glucagon-Like Peptide-1 Receptor Agonists: A Swedish Descriptive Cohort Study
Introduction: In Sweden, glucagon-like peptide-1 (GLP-1) receptor agonists are subsidized for diabetes indication but not for obesity. Unregulated off-label prescription of GLP-1 receptor agonists for obesity treatment may raise concerns about potential inequalities for both patient group...
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| Format: | Article |
| Language: | English |
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Karger Publishers
2025-01-01
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| Series: | Obesity Facts |
| Online Access: | https://karger.com/article/doi/10.1159/000542682 |
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| author | Laura Pazzagli Ylva Trolle Lagerros |
| author_facet | Laura Pazzagli Ylva Trolle Lagerros |
| author_sort | Laura Pazzagli |
| collection | DOAJ |
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Introduction: In Sweden, glucagon-like peptide-1 (GLP-1) receptor agonists are subsidized for diabetes indication but not for obesity. Unregulated off-label prescription of GLP-1 receptor agonists for obesity treatment may raise concerns about potential inequalities for both patient groups. This study aimed to describe socioeconomic and demographic characteristics of on- and off-label users of GLP-1 receptor agonists in persons without a diagnosis of diabetes. Methods: This is a Swedish descriptive register-based cohort study of persons who filled a prescription of a GLP-1 receptor agonist at least once during 2018–2022. Individuals were excluded from the study population if they had a diagnosis of diabetes or previous prescription fills of insulin/analogs at any time prior to the first filled prescription of a GLP-1 receptor agonist. Socioeconomic and demographic characteristics were described overall and stratified by sex and prior use of anti-obesity medications. Off-label use was defined by filled prescriptions of GLP-1 receptor agonists which are indicated for diabetes treatment. Results: The study population included 16,436 individuals, of which 70.1% were women, 30.7% had previously filled a prescription of anti-obesity medications, and 65.3% had Sweden as country of origin and 17.2% an Asian country. In the analyses stratified by sex, women were more likely to have an education longer than 9 years (84.8% vs. 78.3% in men). Nonetheless, women had lower annual individual (2,891.3 vs. 4,004.9 in men) and family disposable income (5,645.5 vs. 6,092.5 in men). Overall, on-label prescription was higher in women (49.2% vs. 30.9% in men), while off-label was more common among men (69% vs. 51% in women). Trends of GLP-1 users per 1,000 inhabitants showed four-fold variation between counties. Conclusion: High family disposable income and male sex are common among off-label GLP-1 receptor agonist users compared to users of the only on-label GLP-1 receptor agonist available in Sweden during the study period. Large variation between counties indicates different clinical practices and guideline interpretations. |
| format | Article |
| id | doaj-art-134fc1510a0f4fc0a3a4f7f1f978ca23 |
| institution | OA Journals |
| issn | 1662-4033 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Obesity Facts |
| spelling | doaj-art-134fc1510a0f4fc0a3a4f7f1f978ca232025-08-20T02:31:55ZengKarger PublishersObesity Facts1662-40332025-01-0118213013810.1159/000542682Socioeconomic and Demographic Inequalities in Off-Label Prescription of Glucagon-Like Peptide-1 Receptor Agonists: A Swedish Descriptive Cohort StudyLaura Pazzaglihttps://orcid.org/0000-0002-1908-6073Ylva Trolle Lagerroshttps://orcid.org/0000-0001-6816-7577 Introduction: In Sweden, glucagon-like peptide-1 (GLP-1) receptor agonists are subsidized for diabetes indication but not for obesity. Unregulated off-label prescription of GLP-1 receptor agonists for obesity treatment may raise concerns about potential inequalities for both patient groups. This study aimed to describe socioeconomic and demographic characteristics of on- and off-label users of GLP-1 receptor agonists in persons without a diagnosis of diabetes. Methods: This is a Swedish descriptive register-based cohort study of persons who filled a prescription of a GLP-1 receptor agonist at least once during 2018–2022. Individuals were excluded from the study population if they had a diagnosis of diabetes or previous prescription fills of insulin/analogs at any time prior to the first filled prescription of a GLP-1 receptor agonist. Socioeconomic and demographic characteristics were described overall and stratified by sex and prior use of anti-obesity medications. Off-label use was defined by filled prescriptions of GLP-1 receptor agonists which are indicated for diabetes treatment. Results: The study population included 16,436 individuals, of which 70.1% were women, 30.7% had previously filled a prescription of anti-obesity medications, and 65.3% had Sweden as country of origin and 17.2% an Asian country. In the analyses stratified by sex, women were more likely to have an education longer than 9 years (84.8% vs. 78.3% in men). Nonetheless, women had lower annual individual (2,891.3 vs. 4,004.9 in men) and family disposable income (5,645.5 vs. 6,092.5 in men). Overall, on-label prescription was higher in women (49.2% vs. 30.9% in men), while off-label was more common among men (69% vs. 51% in women). Trends of GLP-1 users per 1,000 inhabitants showed four-fold variation between counties. Conclusion: High family disposable income and male sex are common among off-label GLP-1 receptor agonist users compared to users of the only on-label GLP-1 receptor agonist available in Sweden during the study period. Large variation between counties indicates different clinical practices and guideline interpretations. https://karger.com/article/doi/10.1159/000542682 |
| spellingShingle | Laura Pazzagli Ylva Trolle Lagerros Socioeconomic and Demographic Inequalities in Off-Label Prescription of Glucagon-Like Peptide-1 Receptor Agonists: A Swedish Descriptive Cohort Study Obesity Facts |
| title | Socioeconomic and Demographic Inequalities in Off-Label Prescription of Glucagon-Like Peptide-1 Receptor Agonists: A Swedish Descriptive Cohort Study |
| title_full | Socioeconomic and Demographic Inequalities in Off-Label Prescription of Glucagon-Like Peptide-1 Receptor Agonists: A Swedish Descriptive Cohort Study |
| title_fullStr | Socioeconomic and Demographic Inequalities in Off-Label Prescription of Glucagon-Like Peptide-1 Receptor Agonists: A Swedish Descriptive Cohort Study |
| title_full_unstemmed | Socioeconomic and Demographic Inequalities in Off-Label Prescription of Glucagon-Like Peptide-1 Receptor Agonists: A Swedish Descriptive Cohort Study |
| title_short | Socioeconomic and Demographic Inequalities in Off-Label Prescription of Glucagon-Like Peptide-1 Receptor Agonists: A Swedish Descriptive Cohort Study |
| title_sort | socioeconomic and demographic inequalities in off label prescription of glucagon like peptide 1 receptor agonists a swedish descriptive cohort study |
| url | https://karger.com/article/doi/10.1159/000542682 |
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