Role of Health Care in Addressing Unhealthy Alcohol Use and Disparities among Aging Women

摘要 不健康饮酒在老年女性中显著增加，增加了她们严重饮酒的风险 相关不良后果。与此同时，她们比男性更不可能获得治疗，这是 在种族/少数民族妇女中加剧了这种情况。医疗保健提供者和系统将面临越来越多的 有酒精问题的老年妇女的数量，通常伴随着可以改善的健康状况 减少饮酒量。目前，关于这一老龄化人口日益增长的需求的研究有限， 包括关于不健康饮酒可能对种族/少数民族妇女造成不成比例的影响 以及如何制定有效的干预措施。了解这些关键差距并提供全面的方法 对于与酒精相关的医疗保健，我们建议对100多万(1,298,009)老年女性进行混合方法研究 (≥，50岁)在一个拥有450多万成员的多元化医疗保健提供系统中。我们利用独特的 来自初级保健中普遍酒精筛查计划的纵向电子健康记录(EHR)数据， 据估计，有784,794名老年妇女在多家初级保健机构定期接受不健康饮酒筛查 2014-2022年间的访问。我们将筛查数据与NIAAA资助的酒精登记相结合，该登记包含 医疗和精神诊断、自我报告健康行为(例如吸烟、锻炼、人际暴力 筛查)，以及在临床环境中遇到的卫生服务。我们的方法是由一个概念性的 融合了交叉理论和安徒生的卫生服务利用模式。我们 首先确定不健康饮酒的趋势和预测因素(定义为超过指南或饮酒 在整体和按年龄和种族/族裔划分的老年妇女中)。第二，我们测试医疗服务是否 利用情况(例如，常规初级保健就诊、短暂的酒精干预、药物治疗以及成瘾和/或 精神病学治疗)与所有老年女性中随着时间的推移酒精使用量的减少有关 不健康的饮酒和有共同健康状况的亚组(例如，慢性疼痛， (抑郁症/焦虑症、糖尿病和高血压)和药物使用(如阿片类药物)。在每个目标上，我们 检查种族/民族差异，以确定潜在的差异。我们使用高级因果模型 分析假设关系的方法，并适当控制潜在的混淆和 偏见。为了更深入地了解这些弱势患者的需求和潜在的护理障碍，我们 对报告不健康饮酒的老年女性和护理人员进行定性访谈 他们在不同的医疗环境中(例如初级保健、老年病、成瘾药物)，我们对这些情况进行三角测量 有了定量的数据。这些发现将提供急需的证据，说明卫生服务如何影响 不健康的饮酒，以便卫生保健系统能够更好地识别和治疗这一弱势群体 通过有针对性的干预。

ABSTRACT Unhealthy alcohol use has increased significantly among aging women, raising their risk of serious alcohol related adverse consequences. At the same time, they are less likely than men to access treatment, and this is exacerbated among racial/ethnic minority women. Health care providers and systems will face an increasing number of aging women with alcohol problems, often with co-occurring health conditions that would improve with reduced drinking. Currently, there is limited research on the growing needs of this aging population, including on how racial/ethnic minority women may be disproportionately impacted by unhealthy alcohol use and on how to develop effective interventions. To understand these critical gaps and inform a holistic approach to alcohol-related healthcare, we propose a mixed-method study of over one million (1,298,009) aging women (≥age 50) in a diverse health care delivery system of over 4.5 million members. We leverage unique longitudinal electronic health record (EHR) data from a universal alcohol screening program in primary care, with an estimated 784,794 aging women regularly screened for unhealthy alcohol use at multiple primary care visits between 2014-2022. We integrate screening data with a NIAAA-funded alcohol registry that contains medical and psychiatric diagnoses, self-report health behaviors (e.g. tobacco, exercise, interpersonal violence screening), and health service encounters across clinical settings. Our approach is guided by a conceptual model that incorporates Intersectionality Theory and the Andersen’s Model of Health Services Utilization. We first identify trends and predictors of unhealthy alcohol use (defined as exceeding guidelines or alcohol use disorder) among aging women overall and by age and race/ethnicity. Second, we test whether health services utilization (e.g., routine primary care visits, brief alcohol interventions, medications, and addiction and/or psychiatry treatment) is associated with reductions in alcohol use over time among all aging women who report unhealthy alcohol use and among subsets with co-occurring health conditions (e.g., chronic pain, depression/anxiety, diabetes and hypertension) and medication use (e.g., opioids). Across each aim, we examine racial/ethnic differences to identify potential disparities. We use advanced causal modeling approaches to analyze hypothesized relationships, and to appropriately control for potential confounding and biases. For a deeper understanding of these vulnerable patients’ needs and potential barriers to care, we conduct qualitative interviews with aging women who report unhealthy alcohol use and with providers who care for them in different medical settings (e.g. primary care, geriatrics, addiction medicine), which we triangulate with the quantitative data. Findings will provide urgently needed evidence on how health services can impact unhealthy alcohol use, so that health care systems can better identify and treat this vulnerable population through targeted interventions.