Variation in receipt of pharmacotherapy for alcohol use disorders across racial/ethnic groups: A national study in the U.S. Veterans Health Administration

Emily C. Williams, Shalini Gupta, Anna D. Rubinsky, Joseph E. Glass, Rhonda Jones-Webb, Kara M. Bensley, Alex H.S. Harris

Research output: Contribution to journalArticlepeer-review

22 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)527-533
Number of pages7
JournalDrug and alcohol dependence
Volume178
DOIs
StatePublished - Sep 1 2017

Bibliographical note

Funding Information:
This study was funded by a Veterans Affairs (VA) Substance Use Disorders Quality Enhancement Research Initiative (SUD QUERI) locally initiated project (QLP 59-031). Dr. Williams is supported by a Career Development Award from VA Health Services Research & Development ( CDA 12-276 ); Dr. Harris is supported by a Career Scientist Award from VA Health Services Research & Development ( RCS-14-232 ). Views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs, the University of Washington, the University of Minnesota or Kaiser Permanente Washington Health Research Institute.

Publisher Copyright:
© 2017

Keywords

  • Alcohol use disorders
  • Ethnicity
  • Medications
  • Pharmacotherapy
  • Race

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