OBJECTIVES: To understand potential disparities in the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) across social determinants of health (SDoH) domains among pediatric patients.

METHODS: Electronic health records (2017 – 2024) from the OMNY Health real-world data platform were accessed, and individuals under 18 years received semaglutide (for weight loss or treatment of type 2 diabetes [T2D]) or tirzepatide were selected. Diagnoses, encounters, prescription orders/administrations, and SDoH survey questions across 5 SDoH domains (economic instability, social issues, educational attainment, transportation access, and health instability) were evaluated at the index prescription. These pediatric GLP-1 RA patients were compared to a peer group who did not receive GLP-1 RAs in 2023.

RESULTS: 699 pediatric patients were prescribed GLP1 RAs; primarily semaglutide for weight loss or T2D (52%; 40%). Median age was 16 years, and the population was mostly female (72%) and white (70%). The top diagnoses were obesity-related conditions, prediabetes, and T2D. Approximately 5% of the population reported greater SDoH burden in any domain, except health instability. Distributions of age, gender, and top diagnoses were similar to the subgroup with poor SDoH measures, most of whom were taking semaglutide for weight loss (47%). Dietary counseling and surveillance was observed in 20% of these patients with greater SDoH burden. Among the 2 million pediatric patients not taking GLP-1 RAs in 2023, a smaller proportion was female (52%) with a median age of 12 years. Top diagnoses in this comparison population were upper respiratory infection, pharyngitis, and acne, and 9% reported greater SDoH burden.

CONCLUSIONS: Pediatric GLP-1 RA use was most prominent in female and white patients, and greater SDoH burden was observed in pediatric patients who did not take GLP-1 RAs. These observations suggest unequal access to GLP-1 RAs among patients with greater SDOH burden, who, in turn, have a greater underlying risk for cardiometabolic conditions.