Finlay Andrea K, Pivovarova Ekaterina, Yu Mengfei, Timko Christine, Binswanger Ingrid A, Smelson David, Taylor Emmeline, Harris Alex H S
VA Palo Alto Health Care System, Menlo Park, USA.
UMass Chan Medical School, Worcester, USA.
Health Justice. 2025 Apr 29;13(1):28. doi: 10.1186/s40352-025-00336-6.
The Veterans Health Administration has made strides to improve access to medications for opioid use disorder overall. However, quality improvement methods to assess treatment gaps may not sufficiently detect differences in medication access by intersecting patient factors, which may have multiplicative rather than additive effects. This study aimed to determine whether race/ethnicity and legal involvement interact in receipt of medications for opioid use disorder among Veterans Health Administration patients.
Using national electronic health record data from Fiscal Years 2021-2022, we examined the receipt of medications for opioid use disorder among veterans diagnosed with opioid use disorder who received healthcare at Veterans Health Administration facilities (n = 65,883). We conducted a mixed effects multivariable logistic regression model to examine an interaction effect of race/ethnicity and legal involvement with receipt of any medications for opioid use disorder, both unadjusted and adjusted for patient and facility characteristics.
In an adjusted logistic regression model, the interaction effect indicated that non-Hispanic Black veterans with legal involvement had the lowest odds of medications for opioid use disorder receipt compared to non-Hispanic White veterans without legal involvement (adjusted odds ratio = 0.67, 95% confidence interval = 0.59-0.77, p <.0001). Non-Hispanic American Indian/Alaska Native patients without legal involvement (adjusted odds ratio = 0.85, 95% confidence interval = 0.73-0.99, p =.04) also had lower odds of receipt of medications for opioid use disorder compared to non-Hispanic White patients without legal involvement. Non-Hispanic White veterans with legal involvement (adjusted odds ratio = 1.07, 95% confidence interval = 1.01-1.14, p =.03) had higher odds of receipt of medications for opioid use disorder compared to non-Hispanic White patients without legal involvement.
Veterans Health Administration quality improvement efforts should monitor interacting racial and legal status factors and understand and address patient, clinical, and regulatory barriers to medications for opioid use disorder among Black veterans with legal involvement.
退伍军人健康管理局在总体上已在改善阿片类药物使用障碍患者获取药物方面取得了进展。然而，用于评估治疗差距的质量改进方法可能无法充分检测出因患者因素相互交织而导致的药物获取差异，这些因素可能具有相乘而非相加的效应。本研究旨在确定在退伍军人健康管理局的患者中，种族/族裔与法律问题在阿片类药物使用障碍药物获取方面是否存在相互作用。
利用2021 - 2022财年的全国电子健康记录数据，我们研究了在退伍军人健康管理局设施接受医疗服务且被诊断为阿片类药物使用障碍的退伍军人中阿片类药物使用障碍药物的获取情况（n = 65,883）。我们进行了一个混合效应多变量逻辑回归模型，以检验种族/族裔与法律问题对任何阿片类药物使用障碍药物获取的相互作用效应，分别在未调整以及针对患者和机构特征进行调整的情况下进行检验。
在调整后的逻辑回归模型中，相互作用效应表明，有法律问题的非西班牙裔黑人退伍军人与没有法律问题的非西班牙裔白人退伍军人相比，获得阿片类药物使用障碍药物的几率最低（调整后的优势比 = 0.67，95%置信区间 = 0.59 - 0.77，p <.0001）。与没有法律问题的非西班牙裔白人患者相比，没有法律问题的非西班牙裔美国印第安/阿拉斯加原住民患者获得阿片类药物使用障碍药物的几率也较低（调整后的优势比 = 0.85，95%置信区间 = 0.73 - 0.99，p = 0.04）。与没有法律问题的非西班牙裔白人患者相比，有法律问题的非西班牙裔白人退伍军人获得阿片类药物使用障碍药物的几率较高（调整后的优势比 = 1.07，95%置信区间 = 1.01 - 1.14，p = 0.03）。
退伍军人健康管理局的质量改进工作应监测相互作用的种族和法律状况因素，并了解和解决有法律问题的黑人退伍军人在获取阿片类药物使用障碍药物方面的患者、临床和监管障碍。
