Evidence map›Paper›PMID 38842176›Full record

ArticleJournal of addiction medicine

Receipt of Medications for Alcohol Use Disorder in the Veterans Health Administration: Comparison of Rates at the Intersections of Racialized and Ethnic Identity With Both Sex and Transgender Status.

Rachel L Bachrach, Madeline C Frost, Olivia V Fletcher, Jessica A Chen, Matthew Chinman, Robert Ellis, Emily C Williams

Abstract read
In one paragraph

Article in Journal of addiction medicine. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Rachel L BachrachFrom the Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI (RLB); Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI (RLB); Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA (MCF, OVF, JAC, ECW); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA (MCF, RE, ECW); The RAND Corporation, Pittsburgh, PA (MC); Center for Health Equity Research and Promotion; Mental Illness Research, Education, and Clinical Center; VA Pittsburgh Healthcare System, Pittsburgh, PA (MC); Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA (MC); and Kaiser Permanente Washington Health Research Institute, Seattle, WA (RE).
Madeline C Frost
Olivia V Fletcher
Jessica A Chen
Matthew Chinman
Robert Ellis
Emily C Williams

Funding

Patterns of Alcohol Use and Alcohol-Related Care Among Transgender PersonsR21AA025973 · NIAAA · UNIVERSITY OF WASHINGTON · PI BLOSNICH, JOHN RUDOLPH, WILLIAMS, EMILY CATERINA · 2018 to 2019
$438k
Patient Readiness for Improvement through Motivation, Engagement, and Decision-making for PTSD (PRIMED-PTSD)IK2HX002866 · VA · VA PUGET SOUND HEALTHCARE SYSTEM · PI CHEN, JESSICA ANN · 2020 to 2025
–
Implementation Intervention to Improve Care for Unhealthy Alcohol UseIK2HX003087 · VA · VETERANS HEALTH ADMINISTRATION · PI BACHRACH, RACHEL LAUREN · 2020 to 2025
–
HSRD VA IK2 HX002866HSRD VA IK2 HX003087NIAAA NIH HHS R21 AA025973
6 · The paper itself

Abstract

objectivesMedications for alcohol use disorder (MAUDs) are recommended for patients with alcohol use disorder yet are underprescribed. Consistent with Minority Stress and Intersectionality theories, persons with multiple sociodemographically marginalized identities (eg, Black women) often experience greater barriers to care and have poorer health outcomes. We use data from the Veterans Health Administration to assess disparities in Federal Drug Administration (FDA)-approved MAUDs and all effective MAUDs between the following groups: racialized and ethnic identity, sex, transgender status, and their intersections.

methodsAmong all Veterans Health Administration outpatients between August 1, 2015, and July 31, 2017, with documented alcohol screenings and an International Classification of Diseases diagnosis for alcohol use disorder in the 0-365 days prior (N = 308,238), we estimated the prevalence and 95% confidence intervals of receiving FDA-approved MAUDs and any MAUDs in the following year and compared them using χ2 or Fisher's exact test. Analyses are unadjusted to present true prevalence and group differences.

resultsThe overall prevalence for MAUDs was low (FDA-MAUDs = 8.7%, any MAUDs = 20.0%). Within sex, Black males had the lowest rate of FDA-MAUDs (7.3%, [7.1-7.5]), whereas American Indian/Alaskan Native females had the highest (18.4%, [13.8-23.0]). Among those identified as transgender, Asian and Black transgender persons had the lowest rates of FDA-MAUDs (0%; 4.3%, [1.8-8.5], respectively), whereas American Indian/Alaskan Native transgender patients had the highest (33.3%, [2.5-64.1]). Similar patterns were observed for any MAUDs, with higher rates overall.

conclusionsSubstantial variation exists in MAUD prescribing, with marginalized veterans disproportionately receiving MAUDs at lower and higher rates than average. Implementation and quality improvement efforts are needed to improve MAUD prescribing practices and reduce disparities.

Indexed as

Healthcare DisparitiesTransgender PersonsUnited States Department of Veterans AffairsAdultAgedAlcohol DeterrentsAlcoholismFemaleHumansMaleMiddle AgedUnited StatesVeteransAlcohol Deterrents

Identifiers

PMID38842176
PMCPMC11446665

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.