Sahker Ethan, Pro George, Sakata Masatsugu, Furukawa Toshiaki A
Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan; Japan Society for the Promotion of Science (JSPS), Overseas Fellowship Division, 5-3-1 Kojimachi, Chiyoda-ku, Tokyo, 102-0083, Japan.
Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, USA.
Drug Alcohol Depend. 2020 Aug 1;213:108087. doi: 10.1016/j.drugalcdep.2020.108087. Epub 2020 May 24.
Racial/ethnic disparities exist at many levels of substance use disorder (SUD) treatment and recovery, reflecting biological and socioeconomic factors. However, racial/ethnic disparities in SUD treatment effectiveness have not been sufficiently investigated.
Data for US outpatient SUD treatment facilities receiving public funding from 2015 to 2017 were analyzed using the Treatment Episode Datasets-Discharge (TEDS-D). The study sample (N = 72,242) were White (n = 51,663), Black (n = 11,789), and Latino (n = 8782) clients reporting substance use frequency at admission and discharge. Multiple logistic regression was used to predict substance use improvement from race/ethnicity, socioeconomic variables, and their interactions. Moderating effects and their clinically meaningful effect sizes of risk differences (RD) were of primary interest.
The simple improvement comparison was statistically significant (χ = 380.59, p < 0.0001). Latino clients improved more (RD = 5.12, 95 % CI = 4.02, 6.22) and Black clients improved less than White clients (RD = -7.93, 95 % CI = -8.93, -6.93). However, race/ethnicity significantly and meaningfully moderated the relationship between substance use improvement and age, employment status, problem substance, and referral source (Wald χ = 5005.94, p < 0.0001).
Latinos demonstrated greater use improvement than Black and White clients. Socioeconomic characteristics moderated this general tendency. Culturally sensitive treatments can be enhanced by addressing culturally specific needs according to client age, employment, specific problem substance, and referral source. For example, Black clients referred from school improved more than Whites and Latinos. Increasing resources for school referrals may further improve Black client outcomes.
物质使用障碍（SUD）治疗与康复的多个层面都存在种族/族裔差异，这反映了生物学和社会经济因素。然而，SUD治疗效果方面的种族/族裔差异尚未得到充分研究。
使用治疗事件数据集-出院（TEDS-D）对2015年至2017年接受公共资金的美国门诊SUD治疗机构的数据进行分析。研究样本（N = 72242）为入院和出院时报告物质使用频率的白人（n = 51663）、黑人（n = 11789）和拉丁裔（n = 8782）客户。采用多元逻辑回归来预测种族/族裔、社会经济变量及其相互作用对物质使用改善情况的影响。主要关注调节效应及其具有临床意义的风险差异（RD）效应大小。
简单的改善情况比较具有统计学意义（χ = 380.59，p < 0.0001）。拉丁裔客户改善程度更高（RD = 5.12，95%置信区间 = 4.02，6.22），黑人客户改善程度低于白人客户（RD = -7.93，95%置信区间 = -8.93，-6.93）。然而，种族/族裔显著且有意义地调节了物质使用改善与年龄、就业状况、问题物质和转诊来源之间的关系（Wald χ = 5005.94，p < 0.0001）。
拉丁裔客户在物质使用改善方面表现出比黑人和白人客户更大的进步。社会经济特征调节了这一总体趋势。通过根据客户年龄、就业、特定问题物质和转诊来源满足文化特定需求，可以加强文化敏感型治疗。例如，从学校转诊来的黑人客户比白人和拉丁裔客户改善得更多。增加学校转诊的资源可能会进一步改善黑人客户的治疗效果。
