INROADS-A: Intersecting Research on Addiction and Disability Services - Alcohol

摘要 残疾人(PWD)是一个被忽视的健康差距人群，他们经常经历 耻辱、歧视、能力主义和较低的社会经济地位。卫生保健的障碍通常很高 PWD，尽管《美国残疾人法》已经实施了三十多年，但许多医疗保健机构 包括成瘾治疗在内的所有治疗方法都不能完全适用于残障人士。最近的研究发现，PWD弃权 酗酒比非残疾人更频繁(PWoD)；然而，在目前的饮酒者中，PWD 高风险饮酒率上升。此外，残障人士上瘾的风险也更大。 身心健康并存、社会孤立、精神创伤史和不良社会病史的比率较高 健康的决定因素。尽管有一系列的风险因素，但人们对饮酒的风险知之甚少。 精神障碍(AUD)或与酒精相关的发病率或后果，或是否存在差异 与PWoD相比，PWD在获得或参与AUD治疗方面的优势。我们将使用严格的准实验 方法使用家庭调查数据(全国药物使用与健康调查)将PWD与PWoD进行比较 和补充医疗索赔数据集(13个州的医疗补助；MarketScan的商业保险) 检查酒精使用、AUD指标、发病率和后果、AUD治疗服务、质量措施 以及按残疾状况划分的结果。残疾状态由调查数据中的功能限制和 索赔中的禁用条件诊断。由于残疾不是同质的，分析将考虑任何 残疾和残疾类型。分析将重复进行，以调查患有 残疾人是一个未得到充分研究和进一步被污名化的群体。 我们的方法是由级联关怀框架组织的，并由交叉性、关键 残疾理论和医学研究所对区分需求相关的医疗保健差异的定义 区别于真正的差异。拟议的具体目标是：1)确定酒精使用的差异， 与酒精相关的发病率，以及按残疾状况进行的AUD诊断；2)在AUD患者中，调查 与酒精相关的发病率、后果和获得非酒精性精神障碍治疗方面的残疾状况差异；以及 3)在接受AUD治疗的人中，根据接受质量一致的残疾状况评估差异 AUD治疗和经历与急性酒精相关的后果。我们对数据源的多方面方法 选择和关注残疾人和残疾人之间的差距将使我们能够更全面地了解 残疾人社区如何受到酒精问题的影响。预计调查结果将为政策制定提供依据 制造商、研究人员和临床医生提供关键信息，以解决在获取、参与、 以及对PWD的AUD治疗的结果，有助于减少与酒精相关的发病率，改善健康 在这一普遍被忽视的健康差距人群中。

Abstract People with disabilities (PWD) are an overlooked health disparity population who routinely experience stigma, discrimination, ableism, and lower socioeconomic status. Barriers to health care are generally high for PWD, and despite over three decades of the Americans with Disabilities Act, many health care settings including addiction treatment are not fully accessible for PWD. Recent studies have found that PWD abstain from alcohol more frequently than people without disabilities (PWoD); however, among current drinkers, PWD have elevated rates of at-risk alcohol use. Furthermore, PWD have greater risk for addiction, given higher rates of mental and physical health comorbidities, social isolation, trauma history and adverse social determinants of health. Despite this constellation of risk factors, very little is known about risk for alcohol use disorder (AUD) or alcohol-related morbidity or consequences among PWD, or whether disparities exist for PWD in accessing or engaging in AUD treatment compared to PWoD. We will use rigorous quasi-experimental methods to compare PWD to PWoD, using household survey data (National Survey on Drug Use and Health) and complementary medical claims datasets (Medicaid in 13 states; commercial insurance in MarketScan) to examine alcohol use, AUD indicators, morbidity and consequences, AUD treatment services, quality measures and outcomes by disability status. Disability status is defined by functional limitations in survey data and by diagnoses of disabling conditions in claims. Because disability is not homogeneous, analyses will consider any disability and types of disability. Analyses will be replicated to investigate outcomes for women with disabilities, an understudied and further stigmatized population. Our approach is organized by the cascade of care framework, and informed by intersectionality, critical disability theory, and the Institute of Medicine definition of health care disparities that separates needs-related differences from true disparities. The proposed specific aims are to: 1) identify differences in alcohol use, alcohol-related morbidity, and AUD diagnoses, by disability status; 2) among people with AUD, investigate disparities by disability status in alcohol-related morbidity, consequences, and access to AUD treatment; and 3) among people receiving AUD treatment, assess disparities by disability status in receiving quality-aligned AUD treatment and experiencing acute alcohol-related outcomes. Our multifaceted approach to data source selection and focus on disparities between PWD and PWoD will allow a more comprehensive picture of how the disability community is affected by alcohol problems. Findings are expected to provide policy makers, researchers, and clinicians with critical information to address disparities in access to, engagement in, and outcomes of AUD treatment for PWD, helping to reduce alcohol-related morbidity and improve the health of this commonly overlooked health disparity population.