Alcohol Research Group, Public Health Institute, Emeryville, California.
Alcohol Research Group, Public Health Institute, Emeryville, California.
Am J Prev Med. 2024 Dec;67(6):932-940. doi: 10.1016/j.amepre.2024.07.017. Epub 2024 Jul 29.
Routine alcohol screening of people with chronic health conditions that are exacerbated by alcohol can help to prevent morbidity and mortality. The U.S. Affordable Care Act and other recent health reforms expanded insurance coverage and supported alcohol screening in primary care. This study assessed increases in alcohol screening following health reform and insurance-related and racial and ethnic disparities in screening.
Data are from the 2013 to 2019 National Surveys on Drug Use and Health for adults with alcohol-related chronic conditions who received primary care in the past year (N=46,014). The outcome was receipt of alcohol screening (yes/no) in which a healthcare provider inquired whether, how often, or how much the respondent drank, or about having alcohol-related problems. Multivariable logistic regression models assessed temporal changes in screening overall and by insurance type and race/ethnicity, adjusting for demographics, health conditions, and primary care utilization. Statistical analysis was performed in 2023.
Alcohol screening prevalence rose from 69% to 77% from 2013 through 2019, with a notable increase in 2014-2015 for both Medicaid-insured and privately-insured patients. Black and Asian American patients were generally less likely to be screened than White patients. Importantly, racial disparities in screening were found among privately-insured patients, patients with hypertension, patients with heart disease, and patients with diabetes who drink alcohol.
Alcohol screening of primary care patients with chronic conditions increased following health reform, but persistent disparities among patients with private insurance and specific chronic conditions underscore the need to address drivers of unequal preventive care.
对因饮酒而加重的慢性健康状况患者进行常规酒精筛查有助于预防发病率和死亡率。美国负担得起的医疗法案和其他最近的医疗改革扩大了保险范围，并支持初级保健中的酒精筛查。本研究评估了医疗改革后以及与保险相关的和种族和民族差异对筛查的影响。
数据来自 2013 年至 2019 年全国药物使用和健康调查，对象为过去一年接受过初级保健的有酒精相关慢性疾病的成年人（N=46014）。结果是接受酒精筛查（是/否），医疗保健提供者询问受访者是否、多久或多少饮酒，或是否有与酒精相关的问题。多变量逻辑回归模型评估了总体筛查以及按保险类型和种族/族裔的变化情况，调整了人口统计学、健康状况和初级保健利用情况。统计分析于 2023 年进行。
2013 年至 2019 年，酒精筛查的流行率从 69%上升到 77%，其中 2014-2015 年 Medicaid 保险和私人保险患者的筛查率显著上升。黑人患者和亚裔美国人患者的筛查率通常低于白人患者。重要的是，在私人保险患者、高血压患者、心脏病患者和饮酒的糖尿病患者中发现了筛查方面的种族差异。
在医疗改革之后，对有慢性疾病的初级保健患者进行酒精筛查有所增加，但私人保险患者和特定慢性疾病患者之间持续存在的差异突出表明需要解决不平等预防保健的驱动因素。
