Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington.
Health Services Research & Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
J Stud Alcohol Drugs. 2022 Nov;83(6):867-878. doi: 10.15288/jsad.21-00110.
Stressful conditions within disadvantaged neighborhoods may shape unhealthy alcohol use and related harms. Yet, associations between neighborhood disadvantage and more severe unhealthy alcohol use are underexplored, particularly for subpopulations. Among national Veterans Health Administration (VA) patients (2013-2017), we assessed associations between neighborhood disadvantage and multiple alcohol-related outcomes and examined moderation by sociodemographic factors.
Electronic health record data were extracted for VA patients with a routine Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) screen. Patient addresses were linked by census block group to the Area Deprivation Index (ADI), dichotomized at the 85th percentile, and examined in quintiles for sensitivity analyses. Using modified Poisson generalized estimating equations models, we estimated associations between neighborhood disadvantage and five outcomes: unhealthy alcohol use (AUDIT-C ≥ 5), any past-year heavy episodic drinking (HED), severe unhealthy alcohol use (AUDIT-C ≥ 8), alcohol use disorder (AUD) diagnosis, and alcohol-specific conditions diagnoses. Moderation by gender, race/ethnicity, and rurality was tested using multiplicative interaction.
Among 6,381,033 patients, residence in a highly disadvantaged neighborhood (ADI ≥ 85th percentile) was associated with a higher likelihood of unhealthy alcohol use (prevalence ratio [PR] = 1.06, 95% CI [1.05, 1.07]), severe unhealthy alcohol use (PR = 1.14, 95% CI [1.12, 1.15]), HED (PR = 1.04, 95% CI [1.03, 1.05]), AUD (PR = 1.14, 95% CI [1.13, 1.15]), and alcohol-specific conditions (PR = 1.21, 95% CI [1.18, 1.24]). Associations were larger for Black and American Indian/Alaska Native patients compared with White patients and for urban compared with rural patients. There was mixed evidence of moderation by gender.
Neighborhood disadvantage may play a role in unhealthy alcohol use in VA patients, particularly those of marginalized racialized groups and those residing in urban areas.
贫困社区的压力环境可能会影响不健康的饮酒行为和相关危害。然而，社区劣势与更严重的不健康饮酒行为之间的关联尚未得到充分探索，特别是对于亚人群。在国家退伍军人健康管理局（VA）患者（2013-2017 年）中，我们评估了社区劣势与多种与酒精相关的结果之间的关联，并检查了社会人口因素的调节作用。
从接受常规酒精使用障碍识别测试-消费（AUDIT-C）筛查的 VA 患者的电子健康记录数据中提取数据。患者的地址通过普查街区组与区域贫困指数（ADI）相关联，ADI 按第 85 百分位数进行二分法，并进行五分位数敏感性分析。使用修正泊松广义估计方程模型，我们估计了社区劣势与五个结果之间的关联：不健康的饮酒行为（AUDIT-C≥5）、任何过去一年的重度饮酒（HED）、严重的不健康饮酒行为（AUDIT-C≥8）、酒精使用障碍（AUD）诊断和酒精特异性疾病诊断。使用乘法交互作用测试性别、种族/民族和农村性别的调节作用。
在 6381033 名患者中，居住在高度劣势社区（ADI≥85 百分位数）与更高的不健康饮酒行为（患病率比 [PR] = 1.06，95%CI [1.05，1.07]）、严重的不健康饮酒行为（PR = 1.14，95%CI [1.12，1.15]）、HED（PR = 1.04，95%CI [1.03，1.05]）、AUD（PR = 1.14，95%CI [1.13，1.15]）和酒精特异性疾病（PR = 1.21，95%CI [1.18，1.24]）的可能性更大。与白人患者相比，黑人和美国印第安人/阿拉斯加原住民患者的关联更大，与农村患者相比，城市患者的关联更大。性别调节作用的证据不一。
社区劣势可能在 VA 患者的不健康饮酒行为中发挥作用，特别是在边缘化的种族群体和居住在城市地区的患者中。
