Racial Inequality in Receipt of Medications for Opioid Use Disorder.
Racial Inequality in Receipt of Medications for Opioid Use Disorder.
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DOI：
10.1056/nejmsa2212412
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发表时间：
2023-05-11
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自2010年以来，美国黑人阿片类药物过量相关死亡率的增加幅度大于其他群体，但在阿片类药物使用障碍（OUD）药物使用方面，表征种族和民族差异的国家级证据有限。我们使用了2016-2019年期间的医疗保险索赔数据，随机抽取了40%的服务费受益人样本，这些受益人是黑人，西班牙裔或白色;由于残疾而有资格获得医疗保险;并且发生了与OUD相关的索引事件（在急诊室或住院治疗的非致命药物过量，因注射药物使用相关感染住院，或住院或住院康复或解毒护理）。我们测量了治疗OUD的药物（丁丙诺啡、纳洛酮和纳洛酮）的接受情况、高风险药物（阿片类镇痛药和苯二氮卓类药物）的接受情况和医疗保健利用情况，所有这些都是在指标事件发生后180天内进行的。我们根据受益人年龄、性别、指标事件、慢性共存疾病计数和居住州调整后的种族和民族，估计了结果的差异。我们在23,370名受益人中确定了25,904起OUD相关指数事件，其中3937起事件（15.2%）发生在黑人患者中，2105起（8.1%）发生在西班牙裔患者中，19,862起（76.7%）发生在白色患者中。在索引事件后180天内，黑人患者中12.7%的事件发生后接受丁丙诺啡治疗，西班牙裔患者中18.7%的事件发生后接受丁丙诺啡治疗，白色患者中23.3%的事件发生后接受丁丙诺啡治疗;分别有14.4%、20.7%和22.9%的患者接受纳洛酮治疗;分别为23.4%、29.6%和37.1%。从2016年至2019年，接受药物治疗OUD的种族差异没有明显变化（接受丁丙诺啡：2016年黑人患者中9.1%的索引事件后vs.白色患者中21.6%的索引事件后，2019年14.1% vs. 25.5%的索引事件后）。在所有研究组中，患者在索引事件后180天内进行了多次门诊访视（平均访视次数，黑人患者为6.6次事件后访视，西班牙裔患者为6.7次事件后访视，白色患者为7.6次事件后访视）。在残疾患者中，在发生与OUD相关的指标事件后，接受药物治疗OUD的种族和民族差异很大，且不随时间变化。所有群体的门诊就诊率都很高，这表明尽管经常接触医疗保健，但差异仍然存在。（由国家药物滥用研究所和国家老龄化研究所资助。
Since 2010, Black persons in the United States have had a greater increase in opioid overdose–related mortality than other groups, but national-level evidence characterizing racial and ethnic disparities in the use of medications for opioid use disorder (OUD) is limited. We used Medicare claims data from the 2016–2019 period for a random 40% sample of fee-for-service beneficiaries who were Black, Hispanic, or White; were eligible for Medicare owing to disability; and had an index event related to OUD (nonfatal overdose treated in an emergency department or inpatient setting, hospitalization with injection drug use–related infection, or inpatient or residential rehabilitation or detoxification care). We measured the receipt of medications to treat OUD (buprenorphine, naltrexone, and naloxone), the receipt of high-risk medications (opioid analgesics and benzodiazepines), and health care utilization, all in the 180 days after the index event. We estimated differences in outcomes according to race and ethnic group with adjustment for beneficiary age, sex, index event, count of chronic coexisting conditions, and state of residence. We identified 25,904 OUD-related index events among 23,370 beneficiaries, with 3937 events (15.2%) occurring among Black patients, 2105 (8.1%) among Hispanic patients, and 19,862 (76.7%) among White patients. In the 180 days after the index event, patients received buprenorphine after 12.7% of events among Black patients, after 18.7% of those among Hispanic patients, and after 23.3% of those among White patients; patients received naloxone after 14.4%, 20.7%, and 22.9%, respectively; and patients received benzodiazepines after 23.4%, 29.6%, and 37.1%, respectively. Racial differences in the receipt of medications to treat OUD did not change appreciably from 2016 to 2019 (buprenorphine receipt: after 9.1% of index events among Black patients vs. 21.6% of those among White patients in 2016, and after 14.1% vs. 25.5% in 2019). In all study groups, patients had multiple ambulatory visits in the 180 days after the index event (mean number of visits, 6.6 after events among Black patients, 6.7 after events among Hispanic patients, and 7.6 after events among White patients). Racial and ethnic differences in the receipt of medications to treat OUD after an index event related to this disorder among patients with disability were substantial and did not change over time. The high incidence of ambulatory visits in all groups showed that disparities persisted despite frequent health care contact. (Funded by the National Institute on Drug Abuse and the National Institute on Aging.)