A population-based examination of trends and disparities in medication treatment for opioid use disorders among Medicaid enrollees
A population-based examination of trends and disparities in medication treatment for opioid use disorders among Medicaid enrollees
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DOI：
10.1080/08897077.2018.1449166
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发表时间：
2018-01-01
期刊：
影响因子：
3.5
通讯作者：
Pacula, Rosalie Liccardo
中科院分区：
文献类型：
--
作者：
Stein, Bradley D.;Dick, Andrew W.;Pacula, Rosalie Liccardo
背景资料：美沙酮和丁丙诺啡的药物治疗（MT）是阿片类药物使用障碍的有效治疗方法，但关于丁丙诺啡的批准导致更多人接受MT的程度以及在多大程度上接受这种治疗在社区中是公平的，信息很少。研究方法：为了研究MT利用率的变化以及MT利用率与县级贫困，种族/民族和城市化指标之间的关联，我们使用了2002-2009年来自14个州的18-64岁非双重资格的医疗补助注册者的医疗补助申请。我们按年（N = 7760个县年）生成了MT（美沙酮、丁丙诺啡和任何MT）的县级汇总计数。我们估计了计数数据模型，以确定MT和县特征之间的关联，包括贫困水平和种族/民族集中度。结果：从2002年到2009年，接受MT的医疗补助注册人数增加了62%。接受美沙酮的登记人数增加了20%，其余的增加来自丁丙诺啡。在2002年和2009年，城市县居民比农村县居民更有可能接受MT。然而，从2002年到2009年，丁丙诺啡大大增加了农村县的MT。与没有这些特征的县的居民相比，贫困率较低、黑人和西班牙裔人口集中度较低的县的居民接受MT的增长率要高得多。结论：在丁丙诺啡批准后的几年里，接受MT的医疗补助注册者的增加是令人鼓舞的。然而，令人关切的是，MT趋势因县人口的特点而变化如此之大，而且在历史上人口在医疗保健获得和质量方面处于不利地位的县，MT利用率的增长率大大降低。需要协调一致的努力，以确保MT的好处在整个社会中公平分配，并惠及可能面临阿片类药物使用障碍风险较高的弱势群体。
Background: Medication treatment (MT) with methadone and buprenorphine are effective treatments for opioid use disorders, but little information is available regarding the extent to which buprenorphine's approval resulted in more individuals receiving MT nor to what extent receipt of such treatment was equitable across communities. Methods: To examine changes in MT utilization and the association between MT utilization and county-level indicators of poverty, race/ethnicity, and urbanicity, we used Medicaid claims of non-dually eligible Medicaid enrollees aged 18-64 from 14 states for 2002-2009. We generated county-level aggregate counts of MT (methadone, buprenorphine, and any MT) by year (N = 7760 county-years). We estimated count data models to identify associations between MT and county characteristics, including levels of poverty and racial/ethnic concentration. Results: The number of Medicaid enrollees receiving MT increased 62% from 2002 to 2009. The number of enrollees receiving methadone increased 20%, with the remaining increase resulting from buprenorphine. Urban county residents were significantly more likely to receive MT in both 2002 and 2009 than rural county residents. However, buprenorphine substantially increased MT in rural counties from 2002 to 2009. Receipt of MT increased at a much higher rate for residents of counties with lower poverty rates and lower concentrations of black and Hispanic individuals than for residents of counties without those characteristics. Conclusions: The increase in Medicaid enrollees receiving MT in the years following buprenorphine's approval is encouraging. However, it is concerning that MT trends varied so dramatically by characteristics of the county population and that increases in utilization were substantially lower in counties with populations that historically have been disadvantaged with respect to health care access and quality. Concerted efforts are needed to ensure that MT benefits are equitably distributed across society and reach disadvantaged individuals who may be at higher risk of experiencing opioid use disorders.