Receipt of Glucagon-Like Peptide-1 Receptor Agonists Among rural Patients with Obstructive Sleep Apnea and Excess Weight

Successful weight loss is more difficult for those with 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 patients with OSA and excess weight living in rural areas. We sought to test the association of rural residence (vs urban) with receipt of GLP-1RAs among patients with OSA and excess weight. Using medical record and administrative data from the VHA, we constructed a 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. Of the 68,862 patients meeting inclusion criteria from 10/1/2017 to 5/1/2023, 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. We used a mixed effects logistic regression model and found that 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. We performed a causal mediation analysis and did not find that this relationship was mediated through the geographic domains of access of drive time and drive distance to primary and specialty care. Further work is needed to understand the factors that continue to drive rural-urban differences in healthcare delivery beyond geographic domains of access.