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

摘要 不健康的酒精使用在老年妇女中显着增加，增加了她们严重酗酒的风险 相关的不良后果。与此同时，她们获得治疗的可能性低于男子，这是 在少数种族/族裔妇女中情况更为严重。卫生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人数，通常同时发生的健康状况将得到改善 减少饮酒。目前，对老龄化人口日益增长的需求的研究有限， 包括少数种族/族裔妇女如何受到不健康饮酒的不成比例的影响 以及如何制定有效的干预措施。了解这些关键差距并为整体方法提供信息 对于与酒精相关的医疗保健，我们提出了一项针对100多万（1，298，009）老年女性的混合方法研究 （≥ 50岁）在一个超过450万成员的多元化医疗保健提供系统中。我们利用独特的 纵向电子健康记录（EHR）数据来自初级保健中的通用酒精筛查计划， 估计有784，794名老年妇女定期在多个初级保健机构接受不健康酒精使用筛查， 2014 - 2022年访问。我们将筛查数据与NIAAA资助的酒精登记处整合， 医学和精神病诊断，自我报告的健康行为（例如，吸烟、锻炼、人际暴力 筛查），以及在临床环境中的健康服务接触。我们的方法是由一个概念性的 该模型结合了交叉性理论和安德森的卫生服务利用模型。我们 首先确定不健康饮酒的趋势和预测因素（定义为超过指导方针或饮酒 疾病）在总体老年妇女中的分布情况，并按年龄和种族/民族分类。第二，我们测试医疗服务 利用（例如，常规初级保健访视，短暂的酒精干预，药物和成瘾和/或 精神病学治疗）与所有老年妇女中随着时间的推移酒精使用的减少有关， 不健康的酒精使用以及在具有共同发生的健康状况的子集中（例如，慢性疼痛， 抑郁/焦虑，糖尿病和高血压）和药物使用（例如，阿片类药物）。在每一个目标，我们 检查种族/民族差异，以确定潜在的差异。我们使用高级因果建模 分析假设关系的方法，并适当控制潜在的混杂因素， 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妇女和护理人员进行定性访谈 为他们在不同的医疗环境（如初级保健，老年病，成瘾医学），我们三角 与定量数据。调查结果将为卫生服务如何产生影响提供急需的证据 不健康的酒精使用，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.