Racial and Ethnic Disparities in Referral Rejection from Postacute Care Facilities among People with Opioid Use Disorder in Massachusetts.

IF 4.2 3区医学 Q1 SUBSTANCE ABUSE Journal of Addiction Medicine Pub Date : 2024-11-08 DOI:10.1097/ADM.0000000000001390

Sophie Rosenmoss, Marc LaRochelle, Benjamin Bearnot, Zoe Weinstein, Kaku So-Armah, Patience Moyo, Shapei Yan, Alexander Y Walley, Simeon D Kimmel

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Abstract

Objectives: The aim of the study was to examine the association between Black, White, and Hispanic or Latino race and ethnicity and referral rejection from private postacute care facilities among hospitalized individuals with opioid use disorder (OUD).

Methods: In this retrospective cohort study, we linked electronic postacute care referrals from Boston Medical Center in 2018 to electronic medical record data, which we used to ascertain OUD status and race and ethnicity. Using multivariable logistic regression, we examined the association between Black, White, and Hispanic or Latino race and ethnicity and referral rejection, adjusting for individual-level characteristics including medication for opioid use disorder treatment type and for facility-level factors using facility random effects.

Results: We identified 159 hospitalizations from 141 individuals with OUD referred to private postacute medical care, corresponding to 1272 referrals to 244 facilities. Hospitalizations comprised 53 (33%) non-Hispanic Black, 28 (18%) Hispanic or Latino, and 78 (49%) non-Hispanic White individuals. In adjusted analyses, referrals for non-Hispanic Black individuals had significantly higher odds of rejection compared to referrals for non-Hispanic White individuals (adjusted odds ratio 1.83, 95% confidence interval [1.24, 2.69], P = 0.002). There were no significant differences between referrals for Hispanic or Latino individuals and non-Hispanic White individuals (adjusted odds ratio 1.11, 95% confidence interval [0.67, 1.84], P = 0.69).

Conclusions: Among people with OUD referred to private postacute care in Massachusetts, non-Hispanic Black individuals were more likely to be rejected compared to non-Hispanic White individuals, demonstrating racism in postacute care admissions. Efforts to address discrimination against people with OUD in postacute care admissions must also address racial equity.

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马萨诸塞州阿片类药物使用失调症患者拒绝转诊的种族和民族差异。

研究目的本研究旨在探讨黑人、白人、西班牙裔或拉丁裔种族和族裔与私立急性期后护理机构拒绝转介阿片类药物使用障碍（OUD）住院患者之间的关联：在这项回顾性队列研究中，我们将 2018 年波士顿医疗中心的电子急性期后护理转诊与电子病历数据联系起来，并利用这些数据确定 OUD 状态以及种族和民族。使用多变量逻辑回归，我们研究了黑人、白人、西班牙裔或拉丁裔种族和民族与转诊拒绝之间的关联，调整了个人层面的特征，包括阿片类药物使用障碍治疗类型的药物，并使用设施随机效应调整了设施层面的因素：我们从 141 名转诊至私立急诊后医疗机构的 OUD 患者中发现了 159 例住院病例，相当于 244 家医疗机构的 1272 例转诊病例。住院患者中有 53 人（33%）为非西班牙裔黑人，28 人（18%）为西班牙裔或拉丁裔，78 人（49%）为非西班牙裔白人。在调整后的分析中，与非西班牙裔白人转诊相比，非西班牙裔黑人转诊被拒绝的几率明显更高（调整后的几率比 1.83，95% 置信区间 [1.24，2.69]，P = 0.002）。西班牙裔或拉丁裔转诊者与非西班牙裔白人转诊者之间没有明显差异（调整后的几率比 1.11，95% 置信区间 [0.67，1.84]，P = 0.69）：结论：在马萨诸塞州被转介到私人后期护理机构的 OUD 患者中，非西班牙裔黑人比非西班牙裔白人更有可能被拒绝，这表明在后期护理机构的收治过程中存在种族歧视。在努力解决在入住护理机构时对 OUD 患者的歧视问题的同时，还必须解决种族平等问题。

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.