RATIONALE: Successful weight loss is difficult for those with obstructive sleep apnea (OSA), and gaps in weight management care are more pronounced in rural areas. Glucagon-Like Peptide-1 Receptor Agonists (GLP-1RAs) are promising agents to improve the effectiveness of weight management care in patients with OSA and excess weight living in rural areas.
OBJECTIVE: We sought to examine the association of rural residence (vs urban) with receipt of GLP-1RAs among patients with OSA and excess weight.
METHODS: Using medical record and administrative data from the Veterans Health Administration, we constructed a national cohort of patients with OSA (defined by the presence of an ICD-10 code for OSA and procedure code for a sleep study) and excess weight (defined as BMI ≥ 27 kg/m2) who participated in a lifestyle program for weight loss. The exposure was rural home address as compared to urban home address as defined by Rural-Urban Commuting Area codes. The outcome was the receipt of GLP-1RAs in the year after index date. We performed a mixed effects logistic regression analysis of the association between rurality and receipt of GLP-1RAs while adjusting for confounding variables. We then performed a model-based causal mediation analysis evaluating two potential mediators of this association: 1) drive time to care and 2) drive distance to care.
RESULTS: Of the 68,680 patients meeting inclusion criteria from 1/1/2018 to 8/1/2023, 26.0% lived in a rural area, and 74.0% lived in an urban area. Overall, 8.0% received a GLP-1RA in the year after index date. Rural residents had ∼10% lesser odds of receipt of a GLP-1RA approved for chronic weight loss in comparison to urban peers, after adjusting for confounders. Drive distance and drive time to primary and specialty care did not mediate this association.
CONCLUSIONS: Rural patients with OSA and excess weight were less likely to receive a GLP-1RA as compared to urban peers. This association was not mediated through drive time or drive distance to care. Further work is needed to understand the factors that contribute to rural-urban differences in healthcare delivery beyond geographic domains of access.
GLP-1 Therapies