British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada.
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Addiction. 2023 Nov;118(11):2128-2138. doi: 10.1111/add.16273. Epub 2023 Jul 24.
Despite the significant burden of alcohol use disorder (AUD) and availability of safe and effective medications for AUD (MAUD), population-level estimates of access and engagement in AUD-related care are limited. The aims of this study were to generate a cascade of care for AUD in British Columbia (BC), Canada, and to estimate the impacts of MAUD on health outcomes.
This was a retrospective population-based cohort study using linked administrative health data.
British Columbia, Canada, 2015-2019.
Using a 20% random sample of BC residents, we identified 7231 people with moderate-to-severe alcohol use disorder (PWAUD; overall prevalence = 0.7%).
We developed a six-stage AUD cascade (from diagnosis to ≥6 months retention in MAUD) among PWAUD. We evaluated trends over time and estimated the impacts of access to MAUD on AUD-related hospitalizations, emergency department visits and death.
Between 2015 and 2019, linkage to AUD-related care decreased (from 80.4% to 46.5%). However, rates of MAUD initiation (11.4% to 24.1%) and retention for ≥1 (7.0% to 18.2%), ≥3 (1.2% to 4.3%) or ≥6 months (0.2% to 1.6%) increased significantly. In adjusted analyses, access to MAUD was associated with reduced odds of experiencing any AUD-related adverse outcomes, with longer retention in MAUD showing a trend to greater odds reduction: adjusted odds ratio (95% CI) ranging from 0.59 (0.48-0.71) for MAUD retention <1 month to 0.37 (0.21-0.67) for ≥6 months retention.
Access to medications for alcohol use disorder among people with moderate-to-severe alcohol use disorder in British Colombia, Canada increased between 2015 and 2019; however, initiation and retention remained low. There was a trend between longer retention in medications for alcohol use disorder and greater reductions in the odds of experiencing alcohol use disorder-related adverse outcomes.
尽管酒精使用障碍（AUD）的负担巨大，且有安全有效的药物可用于治疗 AUD（MAUD），但人群中 AUD 相关治疗的获取和参与情况仍存在局限性。本研究旨在对加拿大不列颠哥伦比亚省（BC）的 AUD 治疗路径进行分析，并评估 MAUD 对健康结果的影响。
这是一项使用链接行政健康数据的回顾性基于人群的队列研究。
加拿大不列颠哥伦比亚省，2015-2019 年。
我们使用不列颠哥伦比亚省居民的 20%随机样本，确定了 7231 名中度至重度酒精使用障碍患者（PWAUD；总体患病率=0.7%）。
我们在 PWAUD 中建立了一个六阶段 AUD 治疗路径（从诊断到 MAUD 治疗≥6 个月）。我们评估了随时间的变化趋势，并估计了获取 MAUD 对 AUD 相关住院、急诊就诊和死亡的影响。
2015 年至 2019 年期间，与 AUD 相关的治疗途径减少（从 80.4%降至 46.5%）。然而，MAUD 起始率（从 11.4%升至 24.1%）和≥1 个月（从 7.0%升至 18.2%）、≥3 个月（从 1.2%升至 4.3%）和≥6 个月（从 0.2%升至 1.6%）的保留率显著增加。在调整后的分析中，获得 MAUD 与 AUD 相关不良结局的可能性降低相关，MAUD 保留时间越长，降低可能性的趋势越明显：调整后的比值比（95%CI）范围为 1 个月以下 MAUD 保留的 0.59（0.48-0.71）至 6 个月以上 MAUD 保留的 0.37（0.21-0.67）。
加拿大不列颠哥伦比亚省中度至重度酒精使用障碍患者获得 MAUD 的机会在 2015 年至 2019 年间有所增加；然而，起始和保留率仍然较低。MAUD 保留时间越长，AUD 相关不良结局的可能性降低幅度越大。
