GLP-1 治疗与健康社会经济梯度的重塑
GLP-1 Therapy and the Reshaping of Socioeconomic Gradients in Health
NBER Working Papers · 2026 · [{"name": "J. Felipe Montano-Campos", "affiliation": []}, {"name": "Bryan Tysinger", "affiliation": []}, {"name": "Dana Goldman", "affiliation": []}, {"name": "Darius N. Lakdawalla", "affiliation": []}]
中文摘要
用于肥胖治疗的 GLP-1 疗法有望带来显著的健康改善，但其收益如何随社会经济和人口群体而异，目前所知甚少。利用一个具有全国代表性的美国成年人微观模拟模型和 Shapley 值分解，我们估计了 GLP-1 治疗的终身健康和经济收益，并考察这些收益在个体间如何变化。最大的差异出现在教育维度上。与队列均值相比，受教育程度低于高中者的终身净社会价值收益约高出 14%，贴现后的广义风险与严重程度调整生命年（GRASA-QALYs）改善幅度大 16–17%，预期寿命增幅高出 20%；而拥有大学学位者在这些结果上的收益比均值低 15–27%。黑人和西班牙裔个体的健康结果与社会价值改善也往往大于白人个体，包括在 GRASA-QALYs、预期寿命上的更大收益，以及糖尿病风险与患病持续时间上的更大降低。女性同样比男性获得更大的预测治疗收益。这些模式与如下观点一致：最大的收益出现在那些在维持行为性体重控制方面面临更大社会经济约束的人群中。因此，GLP-1 创新可能有助于缓解肥胖相关疾病与生存方面的不平等，促进人口健康公平。
Abstract
GLP-1 therapies for obesity promise substantial health improvements, but little is known about how their benefits vary across socioeconomic and demographic groups. Using a nationally representative microsimulation model of US adults and Shapely-value decomposition, we estimate the lifetime health and economic benefits of GLP-1 treatment and examine how those gains vary across individuals. The largest differences emerge across education. Individuals with less than a high school education experience experience roughly 14% higher gains in lifetime net social value, 16-17% larger improvements in discounted generalized risk- and severity-adjusted life-years (GRASA-QALYs), and 20% greater increases in life expectancy relative to the cohort mean, whereas individuals with college degrees experience gains 15-27% below the mean across these outcomes. Black and Hispanic individuals also tend to experience larger improvements in health outcomes and social value than White individuals, including larger gains in GRASA-QALYs and life expectancy and larger reductions in diabetes risk and duration. Females likewise experience larger predicted treatment gains than men. These patterns are consistent with the idea that the largest gains arise among populations facing greater socioeconomic constraints in sustaining behavioral weight control. GLP-1 innovation may therefore mitigate inequality in obesity-related disease and survival, advancing equity in population health.