From the Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, PA (CD, DN); Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (MKM, BS, DP); Division of General Internal Medicine and Geriatrics, School of Medicine, Oregon Health & Science University, Portland, OR (JMZ); and RAND Corporation, Santa Monica, CA (BDS).
J Addict Med. 2024;18(3):335-338. doi: 10.1097/ADM.0000000000001287.
Overdose mortality has risen most rapidly among racial and ethnic minority groups while buprenorphine prescribing has increased disproportionately in predominantly non-Hispanic White urban areas. To identify whether buprenorphine availability equitably meets the needs of diverse populations, we examined the differential geographic availability of buprenorphine in areas with greater concentrations of racial and ethnic minority groups.
Using IQVIA longitudinal prescription data, IQVIA OneKey data, and Microsoft Bing Maps, we calculated 2 outcome measures across the continental United States: the number of buprenorphine prescribers per 1000 residents within a 30-minute drive of a ZIP code, and the number of buprenorphine prescriptions dispensed per capita at retail pharmacies among nearby buprenorphine prescribers. We then estimated differences in these outcomes by ZIP codes' racial and ethnic minority composition and rurality with t tests.
Buprenorphine prescribers per 1000 residents within a 30-minute drive decreased by 3.8 prescribers per 1000 residents in urban ZIP codes (95% confidence interval = -4.9 to -2.7) and 2.6 in rural ZIP codes (95% confidence interval = -3.0 to -2.2) whose populations consisted of ≥5% racial and ethnic minority groups. There were 45% to 55% fewer prescribers in urban areas and 62% to 79% fewer prescribers in rural areas as minority composition increased. Differences in dispensed buprenorphine per capita were similar but larger in magnitude.
Achieving more equitable buprenorphine access requires not only increasing the number of buprenorphine-prescribing clinicians; in urban areas with higher racial and ethnic minority group populations, it also requires efforts to promote greater buprenorphine prescribing among already prescribing clinicians.
在少数族裔群体中，过量死亡率增长最快，而丁丙诺啡的处方量不成比例地增加主要在非西班牙裔白人的城市地区。为了确定丁丙诺啡的供应是否公平地满足了不同人群的需求，我们检查了在少数族裔群体浓度较高的地区丁丙诺啡的差异地理供应情况。
我们使用 IQVIA 纵向处方数据、IQVIA OneKey 数据和 Microsoft Bing Maps，在美国大陆计算了 2 项结果指标：邮政编码 30 分钟车程内每 1000 名居民的丁丙诺啡处方数，以及附近丁丙诺啡处方者在零售药店每人口的丁丙诺啡处方数。然后，我们使用 t 检验估计了这些结果在邮政编码的种族和族裔构成和农村地区的差异。
在城市邮政编码中，30 分钟车程内每 1000 名居民的丁丙诺啡处方数减少了 3.8 名（95%置信区间为-4.9 至-2.7），在农村邮政编码中减少了 2.6 名（95%置信区间为-3.0 至-2.2），其人口中至少有 5%的种族和族裔群体。随着少数民族比例的增加，城市地区的处方者减少了 45%至 55%，农村地区的处方者减少了 62%至 79%。人均分发的丁丙诺啡差异相似，但幅度更大。
实现更公平的丁丙诺啡获取不仅需要增加丁丙诺啡处方医生的数量；在少数族裔群体人口比例较高的城市地区，还需要努力促进已经开处方的医生增加丁丙诺啡的处方。
