Racial and Ethnic Disparities in Medication-Assisted Treatment: Evidence from Louisiana Medicaid During the COVID-19 Pandemic.
Racial and Ethnic Disparities in Medication-Assisted Treatment: Evidence from Louisiana Medicaid During the COVID-19 Pandemic.
复制标题
DOI：
10.1007/s11606-022-07893-8
复制
发表时间：
2023-01
影响因子：
5.7
通讯作者：
Callison, Kevin
中科院分区：
文献类型：
--
作者：
Anderson, Andrew;Walker, Brigham;Shao, Yixue;LaVeist, Thomas A.;Callison, Kevin
方法我们使用路易斯安那州医疗补助索赔数据MAT在2018年1月至2020年12月之间，受益人年龄在13至64岁之间，诊断为SUD。健康评估和数据信息集的措施被用来确定SUD患者和MAT护理。我们按种族和民族（即非西班牙裔黑人、非西班牙裔白色人和西班牙裔）和地理（即国家卫生统计中心定义的农村与城市）绘制了每1000名有SUD的医疗补助受益人每月MAT的变化。然后，我们使用中断时间序列（ITS）模型评估了MAT率的变化，其中包括对2019冠状病毒病前每月线性趋势的估计，路易斯安那州2020年4月和7月2019冠状病毒病感染高峰时的不连续变化，以及与这些高峰相关的每月趋势变化。我们的研究遵循了StroBE报告指南，并被杜兰大学机构审查委员会归类为豁免研究。结果在新冠疫情爆发前，与黑人或西班牙裔受益人相比，白色受益人的MAT率更高（图1）。使用ITS回归模型，我们发现在大流行之前MAT率存在很大的种族差异，并且存在地理差异（表1）。白色农村（478.4，95% CI：464.02，492.81）和城市（469.6，95%置信区间：454.5，484.5）受益人领取的MAT几乎是农村黑人的四倍。（100.05，95% CI：90.6，110.4）和城市（134.9，95% CI：120.5，149.3）受益人之间的2018年1月至2020年3月。与白色受益人相比，西班牙裔农村和城市受益人的MAT率较低，但更具可比性。在COVID-19期间，差距缩小，黑人受益人的MAT率增加了两倍（农村地区增加88.4%，城市地区增加106.4%），西班牙裔受益人减少一半（农村地区增长45.15%，城市地区增长47.81%），白色受益人增加了三分之一（农村增加34%，城市增加31.4%）。
METHODSWe used Louisiana Medicaid claims data for MAT between January 2018 and December 2020 among beneficiaries aged 13 to 64 with a diagnosis of SUD. Health Evaluation and Data Information Set measures were used to identify SUD patients and MAT care. We plotted changes in monthly MAT per 1000 Medicaid beneficiaries with an SUD by race and ethnicity (ie, Black non-Hispanic, White non-Hispanic, and Hispanic) and geography (ie, rural vs. urban as defined by the National Center for Health Statistics). We then assessed changes in MAT rates using interrupted time series (ITS) models that included estimates for a linear monthly pre-COVID-19 trend, discontinuous changes in rates at the April and July 2020 peaks in COVID-19 infections in Louisiana, and changes in monthly trends associated with these peaks. Our study followed the STROBE reporting guidelines and was classified as exempt research by the Tulane Institutional Review Board.RESULTSMAT rates were higher for White beneficiaries compared to Black or Hispanic beneficiaries in the pre-COVID period (Fig. 1). Using ITS regression models, we found large racial disparities in MAT rates before the pandemic and differences by geography (Table 1). White rural (478.4, 95% CI: 464.02, 492.81) and urban (469.6, 95% CI: 454.5, 484.5) beneficiaries received MAT at nearly four times the rate of Black rural (100.05, 95% CI: 90.6, 110.4) and urban (134.9, 95% CI: 120.5, 149.3) beneficiaries between Jan 2018 and March 2020. Hispanic rural and urban beneficiaries had lower but more comparable rates of MAT compared to White beneficiaries. Disparities narrowed during the COVID-19 period, with MAT rates increasing twofold among Black beneficiaries (88.4% increase in rural and 106.4% increase in urban areas), by half among Hispanic beneficiaries (45.15% increase in rural and 47.81% increase in urban areas), and by a third among White beneficiaries (34% increase in rural and 31.4% increase in urban areas).
登录
查看更多内容
影响因子：
3.5
作者：
Stein, Bradley D.;Dick, Andrew W.;Pacula, Rosalie Liccardo
通讯作者：
Pacula, Rosalie Liccardo
影响因子：
3.9
作者：
Nguemeni Tiako MJ
通讯作者：
Nguemeni Tiako MJ
影响因子：
120.7
作者：
Donohue, Julie M.;Jarlenski, Marian P.;Kennedy, Susan
通讯作者：
Kennedy, Susan
影响因子：
3.9
作者：
Mennis, Jeremy;Stahler, Gerald J.
通讯作者：
Stahler, Gerald J.
影响因子：
13.8
作者：
Kilaru, Austin S.;Xiong, Aria;Delgado, Kit
通讯作者：
Delgado, Kit