Opioid use disorder in the United States: Insurance status and treatment access
Opioid use disorder in the United States: Insurance status and treatment access
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DOI：
10.1016/j.drugalcdep.2007.11.018
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发表时间：
2008-04-01
影响因子：
4.2
通讯作者：
Busch, Susan H.
中科院分区：
文献类型：
--
作者：
Becker, William C.;Fiellin, David A.;Busch, Susan H.
背景：在美国，阿片类药物使用障碍患者的保险状况和治疗率尚不清楚。方法：横断面调查：2002-2004年全国药物使用与健康调查（NSDUH）。调查了人口统计学、治疗和保险状况以及存在或不存在阿片类药物使用障碍之间的双变量和多变量关联。结果：在未经调整的分析中，年轻受访者、西班牙裔受访者（OR 1.5; 95% CI 1.1-2.2）、失业受访者（OR 2.6; 95% CI 1.8-3.8）和接受医疗补助的受访者（OR 4.5; 95% CI 2.5-8.3）或缺乏保险的受访者（OR 3.2; 95% CI 1.8-5.9）更容易发生阿片类药物使用障碍。在任何物质使用障碍的未调整分析中，12-16岁的人比非阿片类物质使用障碍更有可能患有阿片类药物使用障碍（OR 3.4; 95% CI 2.0-5.8），女性（男性OR 0.6; 95% CI 0.5-0.7）和失业受访者（OR 1.5; 95% CI 1.02-2.1）也是如此。在过去一年中，只有15.2%的阿片类药物使用障碍患者接受了治疗。接受阿片类药物治疗的受访者获得医疗补助（p < 0.01）、医疗保险（p < 0.01）和其他公共援助（p = 0.01）的比例高于接受其他药物治疗的受访者。与其他药物使用治疗相比，阿片类药物使用治疗更有可能在医院（p = 0.04）和住院康复（p = 0.02）环境中进行。在阿片类药物使用障碍患者中，未就业与接受治疗独立相关（AOR 3.5; 95% CI 1.4-8.5）。结论：在美国，阿片类药物使用障碍患者的高失业率、医疗补助和无保险率以及低治疗率表明，扩大治疗的努力必须包括政策策略，以帮助覆盖有重大治疗障碍的人群。2007爱思唯尔爱尔兰有限公司版权所有。
Background: In the United States, insurance status and rates of treatment for individuals with opioid use disorder are unknown.Methods: Cross-sectional survey: 2002-2004 National Survey on Drug Use and Health (NSDUH). Bivariate and multivariate associations between demographics, treatment and insurance status and presence or absence of opioid use disorder were investigated.Results: On unadjusted analysis, young respondents, respondents of Hispanic ethnicity (OR 1.5; 95% CI 1.1-2.2), unemployed respondents (OR 2.6; 95% CI 1.8-3.8) and respondents with Medicaid (OR 4.5; 95% CI 2.5-8.3) or lack of insurance (OR 3.2; 95% CI 1.8-5.9) were more likely to have opioid use disorder. On unadjusted analysis among those with any substance use disorder, 12-16 year olds were more likely to have opioid use disorder (OR 3.4; 95% CI 2.0-5.8) than a non-opioid substance use disorder, as were women (OR for men 0.6; 95% CI 0.5-0.7) and unemployed respondents (OR 1.5; 95% CI 1.02-2.1). Only 15.2% of those with past-year opioid use disorder received treatment in the past year. Respondents treated for opioid use had higher rates of Medicaid (p < 0.01), Medicare (p < 0.01) and other public assistance (P = 0.01) compared with those treated for other substances. Treatments for opioid use were more likely to be hospital (p = 0.04) and inpatient rehabilitation (p = 0.02) settings compared to treatment for other substance use. Among those with opioid use disorder, not being employed was independently associated with receiving treatment (AOR 3.5; 95% CI 1.4-8.5).Conclusions: In the U.S., high rates of unemployment, Medicaid and uninsurance among those with opioid use disorder and low rates of treatment suggest that efforts to expand treatment must include policy strategies to help reach a population with significant barriers to treatment access. (c) 2007 Elsevier Ireland Ltd. All rights reserved.