Center for Value-Based Care Research, Cleveland Clinic (Le, Rich, Gasoyan, Rothberg) and Department of Pharmacy and Center for Geriatric Medicine, Cleveland Clinic, Cleveland, Ohio (Ayers); Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland (Rich); Department of General Internal Medicine, Massachusetts General Hospital, Boston (Bernstein); Kaiser Permanente Washington Health Research Institute, Seattle (Glass); Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, and Ralph H. Johnson VA Healthcare System, Charleston (Back); TSET Health Promotion Research Center, Stephenson Cancer Center, and Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City (Bui).
Am J Psychiatry. 2024 Nov 1;181(11):973-987. doi: 10.1176/appi.ajp.20230730.
The authors examined racial/ethnic and socioeconomic disparities in receiving treatment for alcohol use disorder (AUD).
A retrospective cohort study was conducted that included adults (≥18 years) with AUD from the All of Us Controlled Tier database v7. Outcomes were lifetime receipt of FDA-approved medications (disulfiram, acamprosate, and naltrexone), psychotherapy (individual, family, and group-based session), and combination treatment (medication and psychotherapy). The study examined treatment receipt by race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, other), insurance (private, Medicare, Medicare and Medicaid, Medicaid, Veteran Affairs [VA], none), income (<$10K, $10-<$50K, $50-$100K, >$100K), and area deprivation index (ADI) quintiles. Multivariable logistic and multinomial logistic regressions were used to assess the association between patient characteristics and treatment receipt.
The cohort consisted of 18,692 patients (mean age=57.1 years; 60.7% were male; 47.1% were non-Hispanic White). Almost 70% received no treatment, 11.4% received medication, 24.0% received psychotherapy, and 4.9% received combination treatment. In adjusted analysis, non-Hispanic Black (aOR=0.78, 95% CI=0.69-0.89) and Hispanic (aOR=0.75, 95% CI=0.64-0.88) individuals were less likely to receive medication than non-Hispanic White counterparts. There was no association between race/ethnicity and receipt of psychotherapy or combination treatment. Compared with private insurance, dual eligibility was associated with less use of medication, Medicare and Medicaid with less use of medication and combination treatment, and VA and no insurance with more use of psychotherapy and combination treatment. Higher income and lower ADI were positively associated with all treatment types.
There are disparities in AUD treatment by race/ethnicity, socioeconomic status, and insurance. Systematic approaches are required to improve equitable access to effective treatment.
作者研究了接受酒精使用障碍（AUD）治疗方面的种族/民族和社会经济差异。
本研究进行了一项回顾性队列研究，纳入了来自“所有美国人控制层数据库 v7”的成年人（≥18 岁），这些成年人患有 AUD。结局为终身接受 FDA 批准的药物（双硫仑、安考来复和纳曲酮）、心理治疗（个体、家庭和团体治疗）和联合治疗（药物和心理治疗）。本研究通过种族/民族（非西班牙裔白人、非西班牙裔黑人、西班牙裔、其他）、保险（私人、医疗保险、医疗保险和医疗补助、医疗补助、退伍军人事务部 [VA]、无保险）、收入（<10K、$10-<$50K、$50-$100K、>$100K）和区域剥夺指数（ADI）五分位数来检查治疗的接受情况。多变量逻辑回归和多项逻辑回归用于评估患者特征与治疗接受情况之间的关系。
该队列包括 18692 名患者（平均年龄=57.1 岁；60.7%为男性；47.1%为非西班牙裔白人）。近 70%的患者未接受任何治疗，11.4%接受药物治疗，24.0%接受心理治疗，4.9%接受联合治疗。在调整分析中，非西班牙裔黑人（aOR=0.78，95%CI=0.69-0.89）和西班牙裔（aOR=0.75，95%CI=0.64-0.88）患者接受药物治疗的可能性低于非西班牙裔白人。种族/民族与接受心理治疗或联合治疗之间没有关联。与私人保险相比，双重资格与药物治疗的使用减少有关，医疗保险和医疗补助与药物治疗和联合治疗的使用减少有关，VA 和无保险与心理治疗和联合治疗的使用增加有关。较高的收入和较低的 ADI 与所有治疗类型呈正相关。
AUD 治疗存在种族/民族、社会经济地位和保险方面的差异。需要采取系统的方法来改善获得有效治疗的公平性。
