Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, 98195, USA.
Kaiser Permanente Washington Health Research Institute, Seattle, WA, 98101, USA.
Addict Sci Clin Pract. 2024 Aug 30;19(1):61. doi: 10.1186/s13722-024-00490-6.
Diagnosis of alcohol use disorder (AUD) in primary care is critical for increasing access to alcohol treatment. However, AUD is underdiagnosed and may be inequitably diagnosed due to societal structures that determine access to resources (e.g., structural racism that limits opportunities for some groups and influences interpersonal interactions in and beyond health care). This study described patterns of provider-documented AUD in primary care across intersections of race, ethnicity, sex, and community-level socioeconomic status (SES).
This cross-sectional study used EHR data from a regional healthcare system with 35 primary care clinics that included adult patients who completed alcohol screenings between 3/1/2015 and 9/30/2020. The prevalence of provider-documented AUD in primary care based on International Classification of Diseases-9 (ICD-9) and ICD-10 diagnoses was compared across intersections of race, ethnicity, sex, and community-level SES.
Among 439,375 patients, 6.6% were Latine, 11.0% Asian, 5.4% Black, 1.3% Native Hawaiian/Pacific Islander (NH/PI), 1.5% American Indian/Alaska Native (AI/AN), and 74.2% White, and 58.3% women. The overall prevalence of provider-documented AUD was 1.0% and varied across intersecting identities. Among women, the prevalence was highest for AI/AN women with middle SES, 1.5% (95% CI 1.0-2.3), and lowest for Asian women with middle SES, 0.1% (95% CI 0.1-0.2). Among men, the prevalence was highest for AI/AN men with high and middle SES, 2.0% (95% CI 1.1-3.4) and 2.0% (95% CI 1.2-3.2), respectively, and lowest for Asian men with high SES, 0.5% (95% CI 0.3-0.7). Black and Latine patients tended to have a lower prevalence of AUD than White patients, across all intersections of sex and SES except for Black women with high SES. There were no consistent patterns of the prevalence of AUD diagnosis that emerged across SES.
The prevalence of provider-documented AUD in primary care was highest in AI/AN men and women and lowest in Asian men and women. Findings of lower prevalence of provider-documented AUD in Black and Hispanic than White patients across most intersections of sex and SES differed from prior studies. Findings may suggest that differences in access to resources, which vary in effects across these identity characteristics and lived experiences, influence the diagnosis of AUD in clinical care.
在初级保健中诊断酒精使用障碍（AUD）对于增加获得酒精治疗的机会至关重要。然而，由于决定资源获取的社会结构（例如，结构性种族主义限制了某些群体的机会，并影响了医疗保健内外的人际互动），AUD 的诊断不足，而且可能存在不公平的诊断。本研究描述了在种族、族裔、性别和社区层面社会经济地位（SES）交叉点上，初级保健提供者记录的 AUD 模式。
本横断面研究使用了一个地区医疗保健系统的电子健康记录（EHR）数据，该系统有 35 个初级保健诊所，其中包括 2015 年 3 月 1 日至 2020 年 9 月 30 日期间完成酒精筛查的成年患者。根据国际疾病分类第 9 版（ICD-9）和 ICD-10 诊断，比较了初级保健提供者记录的 AUD 在种族、族裔、性别和社区层面 SES 交叉点上的流行率。
在 439375 名患者中，6.6%为拉丁裔，11.0%为亚裔，5.4%为黑人，1.3%为夏威夷原住民/太平洋岛民（NH/PI），1.5%为美洲印第安人/阿拉斯加原住民（AI/AN），74.2%为白人，58.3%为女性。提供者记录的 AUD 的总体流行率为 1.0%，并在交叉身份之间存在差异。在女性中，中 SES 的 AI/AN 女性的患病率最高，为 1.5%（95%CI 1.0-2.3），而中 SES 的亚裔女性的患病率最低，为 0.1%（95%CI 0.1-0.2）。在男性中，高 SES 和中 SES 的 AI/AN 男性的患病率最高，分别为 2.0%（95%CI 1.1-3.4）和 2.0%（95%CI 1.2-3.2），而高 SES 的亚裔男性的患病率最低，为 0.5%（95%CI 0.3-0.7）。与白人患者相比，除了高 SES 的黑人女性外，黑人和拉丁裔患者的 AUD 患病率普遍较低，在所有性别和 SES 交叉点上都是如此。除了高 SES 的黑人女性外，SES 之间 AUD 诊断流行率没有一致的模式。
初级保健提供者记录的 AUD 的流行率在 AI/AN 男性和女性中最高，在亚裔男性和女性中最低。与大多数性别和 SES 交叉点上的白人患者相比，黑人和西班牙裔患者 AUD 的提供者记录率较低，这与之前的研究结果不同。研究结果可能表明，资源获取方面的差异（这些差异在这些特征和生活经历方面的影响各不相同）影响了临床护理中 AUD 的诊断。
