Treatment inequality persists in individuals with AUD

Racial/ethnic and socioeconomic disparities exist in the treatment of individuals with alcohol use disorder (AUD), a study has found.

In this retrospective cohort study, a team of investigators analysed a total of 18,692 adults with AUD (mean age 57.1 years, 60.7 percent males, 47.1 percent non-Hispanic White) from the All of Us Controlled Tier database v7.

Outcomes assessed were lifetime receipt of FDA-approved medications (ie, disulfiram, acamprosate, and naltrexone), psychotherapy (ie, individual, family, and group-based session), and combination treatment (ie, medication plus psychotherapy).

The investigators assessed treatment receipt by race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, other), insurance (private, Medicare, Medicare and Medicaid, Medicaid, Veteran Affairs [VA], none), income (<$10K, $10–<$50K, $50–$100K, >$100K), and area deprivation index (ADI) quintiles.

The association between patient characteristics and treatment receipt were examined using multivariable logistic and multinomial logistic regressions.

Of the participants, 70 percent did not receive treatment, 11.4 percent received medication, 24.0 percent received psychotherapy, and 4.9 percent received combination treatment.

Adjusted analysis revealed that non-Hispanic Black (adjusted odds ratio [aOR], 0.78, 95 percent confidence interval [CI], 0.69–0.89) and Hispanic individuals (aOR, 0.75, 95 percent CI, 0.64–0.88) were less likely to receive medications than non-Hispanic White counterparts. No association was seen between race/ethnicity and receipt of psychotherapy or combination treatment.

Compared with private insurance, dual eligibility correlated with less use of medication, Medicare and Medicaid with less use of medication and combination treatment, and VA and no insurance with more use of psychotherapy and combination treatment. In addition, higher income and lower ADI showed a positive association with all treatment types.

"Systematic approaches are required to improve equitable access to effective treatment,” the investigators said.