Abstract Body (Do not enter title and authors here): Introduction
Cardiovascular-kidney-metabolic (CKM) syndrome disproportionately affects individuals with adverse social determinants of health (SDOH). While glucagon-like peptide-1 receptor agonists (GLP-1RAs) improve outcomes in CKM syndrome, inequitable access (e.g., coverage, supply constraints) may worsen health disparities in CKM syndrome.

Aims
To characterize the association of individual- and community-level SDOH with GLP-1RA use among Medicare beneficiaries with diabetes.

Methods
Cross-sectional study using 100% Medicare claims linked with the Social Vulnerability Index and the US Department of Agriculture Rural-Urban Commuting Area Codes. We evaluated Medicare Advantage and fee-for-service beneficiaries ≥65 years with diabetes enrolled in Part D in 2021 (last year available). Filled prescriptions for GLP-1RAs were identified using National Drug Codes. Baseline characteristics were compared using standardized mean differences. Associations between SDOH (self-identified race and ethnicity, insurance status, social vulnerability index, median household income, rurality, US census region) and GLP-1RA use was evaluated using multivariate logistic regression adjusted for age, sex, and clinical characteristics.

Results
Of 13,429,963 adults with diabetes included in the analysis, mean age was 77y and 54.6% were female. During the 1-year study period, 8.5% (475,719) filled ≥1 GLP-1RA prescriptions and were more likely to be younger, have obesity and chronic kidney disease. After adjustment, race and ethnicity were associated with GLP-1 RA use (Compared with non-Hispanic pregnancy: Black race, OR 0.74 (95% CI: 0.73– 0.75); Asian American race, OR 0.80 (0.78– 0.81); Native American, OR, 1.56 (1.50 –1.62); and Hispanic ethnicity 0.91 (0.89–0.93). Medicare Advantage enrollees had lower odds of use than fee-for-service Medicare: OR, 1.18 (1.17 – 1.19). Dual enrollee status, higher median household income, rurality, and higher social vulnerability were associated with greater use.

Conclusions
There is substantial variability in the use of GLP-1RAs by individual-level and community-level SDOH factors. Determining the drivers of differential access is urgently needed to enhance equitable use.