Receipt of Medications for Alcohol Use Disorder in the Veterans Health Administration: Comparison of Rates at the Intersections of Racialized and Ethnic Identity With Both Sex and Transgender Status.

IF 4.2 3区医学 Q1 SUBSTANCE ABUSE Journal of Addiction Medicine Pub Date : 2024-09-01 Epub Date: 2024-06-05 DOI:10.1097/ADM.0000000000001323

Rachel L Bachrach, Madeline C Frost, Olivia V Fletcher, Jessica A Chen, Matthew Chinman, Robert Ellis, Emily C Williams

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Abstract

Objectives: Medications for alcohol use disorder (MAUDs) are recommended for patients with alcohol use disorder yet are underprescribed. Consistent with Minority Stress and Intersectionality theories, persons with multiple sociodemographically marginalized identities (eg, Black women) often experience greater barriers to care and have poorer health outcomes. We use data from the Veterans Health Administration to assess disparities in Federal Drug Administration (FDA)-approved MAUDs and all effective MAUDs between the following groups: racialized and ethnic identity, sex, transgender status, and their intersections.

Methods: Among all Veterans Health Administration outpatients between August 1, 2015, and July 31, 2017, with documented alcohol screenings and an International Classification of Diseases diagnosis for alcohol use disorder in the 0-365 days prior (N = 308,238), we estimated the prevalence and 95% confidence intervals of receiving FDA-approved MAUDs and any MAUDs in the following year and compared them using χ2 or Fisher's exact test. Analyses are unadjusted to present true prevalence and group differences.

Results: The overall prevalence for MAUDs was low (FDA-MAUDs = 8.7%, any MAUDs = 20.0%). Within sex, Black males had the lowest rate of FDA-MAUDs (7.3%, [7.1-7.5]), whereas American Indian/Alaskan Native females had the highest (18.4%, [13.8-23.0]). Among those identified as transgender, Asian and Black transgender persons had the lowest rates of FDA-MAUDs (0%; 4.3%, [1.8-8.5], respectively), whereas American Indian/Alaskan Native transgender patients had the highest (33.3%, [2.5-64.1]). Similar patterns were observed for any MAUDs, with higher rates overall.

Conclusions: Substantial variation exists in MAUD prescribing, with marginalized veterans disproportionately receiving MAUDs at lower and higher rates than average. Implementation and quality improvement efforts are needed to improve MAUD prescribing practices and reduce disparities.

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退伍军人健康管理局中接受酒精使用障碍药物治疗的情况：种族和民族身份与性别和变性身份交叉点的比率比较。

目的：建议酒精使用障碍（MAUDs）患者服用治疗酒精使用障碍的药物，但这些药物的处方量不足。根据少数群体压力和交叉性理论，具有多重社会经济边缘化身份的人（如黑人妇女）通常会遇到更多的护理障碍，健康状况也会更差。我们利用退伍军人健康管理局（Veterans Health Administration）的数据来评估联邦药物管理局（FDA）批准的MAUDs和所有有效的MAUDs在以下群体之间的差异：种族和民族身份、性别、变性身份及其交叉：在 2015 年 8 月 1 日至 2017 年 7 月 31 日期间的所有退伍军人健康管理局门诊患者中，在之前的 0-365 天内有记录的酒精筛查和国际疾病分类中的酒精使用障碍诊断（N = 308,238 例），我们估算了次年接受 FDA 批准的 MAUDs 和任何 MAUDs 的患病率和 95% 置信区间，并使用 χ2 或费雪精确检验对其进行比较。分析未经调整，以呈现真实的流行率和组间差异：MAUDs的总体流行率较低（FDA-MAUDs = 8.7%，任何MAUDs = 20.0%）。就性别而言，黑人男性的 FDA-MAUDs 感染率最低（7.3%，[7.1-7.5]），而美国印第安人/阿拉斯加原住民女性的感染率最高（18.4%，[13.8-23.0]）。在变性人中，亚裔和黑人变性人的 FDA-MAUDs 感染率最低（分别为 0%；4.3%，[1.8-8.5]），而美国印第安人/阿拉斯加原住民变性人感染率最高（33.3%，[2.5-64.1]）。任何一种MAUDs都有类似的模式，总体比例较高：结论：MAUDs 处方存在巨大差异，边缘化退伍军人接受 MAUDs 的比例过高，低于平均水平，也高于平均水平。需要开展实施和质量改进工作，以改善 MAUD 处方实践并减少差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Addiction Medicine 医学-药物滥用

CiteScore

6.10

自引率

9.10%

发文量

260

审稿时长

>12 weeks

期刊介绍： The mission of Journal of Addiction Medicine, the official peer-reviewed journal of the American Society of Addiction Medicine, is to promote excellence in the practice of addiction medicine and in clinical research as well as to support Addiction Medicine as a mainstream medical sub-specialty. Under the guidance of an esteemed Editorial Board, peer-reviewed articles published in the Journal focus on developments in addiction medicine as well as on treatment innovations and ethical, economic, forensic, and social topics including: •addiction and substance use in pregnancy •adolescent addiction and at-risk use •the drug-exposed neonate •pharmacology •all psychoactive substances relevant to addiction, including alcohol, nicotine, caffeine, marijuana, opioids, stimulants and other prescription and illicit substances •diagnosis •neuroimaging techniques •treatment of special populations •treatment, early intervention and prevention of alcohol and drug use disorders •methodological issues in addiction research •pain and addiction, prescription drug use disorder •co-occurring addiction, medical and psychiatric disorders •pathological gambling disorder, sexual and other behavioral addictions •pathophysiology of addiction •behavioral and pharmacological treatments •issues in graduate medical education •recovery •health services delivery •ethical, legal and liability issues in addiction medicine practice •drug testing •self- and mutual-help.