TY - JOUR
T1 - Variation in receipt of pharmacotherapy for alcohol use disorders across racial/ethnic groups
T2 - A national study in the U.S. Veterans Health Administration
AU - Williams, Emily C.
AU - Gupta, Shalini
AU - Rubinsky, Anna D.
AU - Glass, Joseph E.
AU - Jones-Webb, Rhonda
AU - Bensley, Kara M.
AU - Harris, Alex H.S.
N1 - Publisher Copyright:
© 2017
PY - 2017/9/1
Y1 - 2017/9/1
N2 - Objective Pharmacologic treatment is recommended for alcohol use disorders (AUD), but most patients do not receive it. Although racial/ethnic minorities have greater AUD consequences than whites, whether AUD medication receipt varies across race/ethnicity is unknown. We evaluate this in a national sample. Methods Electronic health records data were extracted for all black, Hispanic, and/or white patients who received care at the U.S. Veterans Health Administration (VA) during Fiscal Year 2012 and had a documented AUD diagnosis. Mixed effects regression models, with a random effect for facility, determined the likelihood of receiving AUD pharmacotherapy (acamprosate, disulfiram, topirimate or oral or injectable naltrexone ≤180 days after AUD diagnosis) for black and Hispanic patients relative to white patients. Models were unadjusted and then adjusted for patient- and facility-level factors. Results 297,506 patients had AUD; 26.4% were black patients, 7.1% were Hispanic patients and 66.5% were white patients; 5.1% received AUD medications. Before adjustment, black patients were less likely than white [Odds Ratio (OR) 0.77; 95% Confidence Interval (CI) 0.75 −0.82; (p < 0.001)], while Hispanic patients were more likely than white (OR 1.09; 95% CI 1.01–1.16) to receive AUD medications. After adjustment, black patients remained less likely than white to receive AUD medications (OR 0.68; 95% CI 0.65–0.71; p < 0.0001); no difference between Hispanic and white patients was observed (OR 0.94; 95% CI 0.87–1.00; p = 0.07). Conclusions In this national study of patients with AUD, blacks were less likely to receive AUD medications than whites. Future research is needed to identify why these disparities exist.
AB - Objective Pharmacologic treatment is recommended for alcohol use disorders (AUD), but most patients do not receive it. Although racial/ethnic minorities have greater AUD consequences than whites, whether AUD medication receipt varies across race/ethnicity is unknown. We evaluate this in a national sample. Methods Electronic health records data were extracted for all black, Hispanic, and/or white patients who received care at the U.S. Veterans Health Administration (VA) during Fiscal Year 2012 and had a documented AUD diagnosis. Mixed effects regression models, with a random effect for facility, determined the likelihood of receiving AUD pharmacotherapy (acamprosate, disulfiram, topirimate or oral or injectable naltrexone ≤180 days after AUD diagnosis) for black and Hispanic patients relative to white patients. Models were unadjusted and then adjusted for patient- and facility-level factors. Results 297,506 patients had AUD; 26.4% were black patients, 7.1% were Hispanic patients and 66.5% were white patients; 5.1% received AUD medications. Before adjustment, black patients were less likely than white [Odds Ratio (OR) 0.77; 95% Confidence Interval (CI) 0.75 −0.82; (p < 0.001)], while Hispanic patients were more likely than white (OR 1.09; 95% CI 1.01–1.16) to receive AUD medications. After adjustment, black patients remained less likely than white to receive AUD medications (OR 0.68; 95% CI 0.65–0.71; p < 0.0001); no difference between Hispanic and white patients was observed (OR 0.94; 95% CI 0.87–1.00; p = 0.07). Conclusions In this national study of patients with AUD, blacks were less likely to receive AUD medications than whites. Future research is needed to identify why these disparities exist.
KW - Alcohol use disorders
KW - Ethnicity
KW - Medications
KW - Pharmacotherapy
KW - Race
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U2 - 10.1016/j.drugalcdep.2017.06.011
DO - 10.1016/j.drugalcdep.2017.06.011
M3 - Article
C2 - 28728114
AN - SCOPUS:85030474487
SN - 0376-8716
VL - 178
SP - 527
EP - 533
JO - Drug and alcohol dependence
JF - Drug and alcohol dependence
ER -