MOUD use among Hispanic clients increased post-ACA, yet differed by heritage and geographic location

IF 3.9 2区 医学 Q1 PSYCHIATRY
Carolina-Nicole Herrera , Sugy Choi , Natrina L. Johnson
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引用次数: 0

Abstract

Background

Overdose death rates for Hispanic people rose 2010–2022. Opioid overdose rates grew faster among Hispanic people than non-Hispanic White people (“White”). Medication for opioid use disorder (MOUD) is an effective but underutilized intervention for decreasing overdose risk. The Affordable Care Act (“ACA”) should have increased MOUD use, but insurance and behavioral health reforms differed by state. We examined to what extent MOUD use increased post-ACA implementation and differed for Hispanic people (overall and by heritage group) compared to White people who used opioids (“clients”).

Methods

We analyzed first annual ambulatory care episodes (TEDS-A, 2009–2019) for working-age Hispanic (N= 76,591) and White (N=444,753) clients. We categorized Hispanic clients by heritage group (Puerto Rican, Mexican, or Other Hispanic). We grouped states by Medicaid expansion status (California, Other Expansion States, and Non-Expansion States). We used logistic regression to compare the odds of MOUD use pre/post ACA within racial/heritage groups, and, separately, between racial/heritage groups using pre-ACA White clients as a reference group. We used linear probability difference-in-differences to confirm changes in MOUD use between Hispanic and White clients.

Results

Among Hispanic clients in ambulatory care, MOUD use was lowest in the Non-Expansion States and highest in California. Nationally, only Puerto Rican and Other Hispanic heritage clients had higher odds of MOUD post-ACA compared to pre-ACA. Nationally and in Other Expansion States, Hispanic and White clients had similar increases in MOUD use post-ACA.

Conclusions

MOUD use among Hispanic clients rose post-ACA, but differences remained between Hispanic heritage groups and between states.
西班牙裔客户的mod使用在aca后有所增加,但因传统和地理位置而异。
背景:2010-2022年,西班牙裔人群的药物过量死亡率上升。西班牙裔的阿片类药物过量率比非西班牙裔白人(“白人”)增长得更快。药物治疗阿片类药物使用障碍(mod)是一种有效的但未充分利用的干预措施,以减少过量的风险。《平价医疗法案》(ACA)本应增加mod的使用,但保险和行为健康改革因州而异。我们研究了在aca实施后,与使用阿片类药物的白人(“客户”)相比,西班牙裔人(总体和传统群体)使用mod的程度增加了多少。方法:我们分析了工作年龄西班牙裔(N= 76,591)和白人(N=444,753)患者的首次年度门诊护理事件(ted -a, 2009-2019)。我们根据传统群体(波多黎各人、墨西哥人或其他西班牙人)对西班牙裔客户进行分类。我们根据医疗补助扩张状态对各州进行分组(加利福尼亚、其他扩张州和非扩张州)。我们使用逻辑回归来比较不同种族/传统群体在ACA之前/之后使用mod的几率,并单独比较不同种族/传统群体之间使用ACA之前的白人客户作为参照组。我们使用线性概率差异中的差异来确认西班牙裔和白人患者在mod使用方面的变化。结果:在西班牙裔门诊病人中,mod的使用在非扩张州最低,在加利福尼亚州最高。在全国范围内,只有波多黎各和其他西班牙裔客户在aca后与aca前相比有更高的mod几率。在全国范围内和其他扩张州,西班牙裔和白人客户在aca后使用mod的数量也有类似的增加。结论:在aca后,西班牙裔客户的mod使用率上升,但西班牙裔传统群体之间和州之间仍然存在差异。
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来源期刊
Drug and alcohol dependence
Drug and alcohol dependence 医学-精神病学
CiteScore
7.40
自引率
7.10%
发文量
409
审稿时长
41 days
期刊介绍: Drug and Alcohol Dependence is an international journal devoted to publishing original research, scholarly reviews, commentaries, and policy analyses in the area of drug, alcohol and tobacco use and dependence. Articles range from studies of the chemistry of substances of abuse, their actions at molecular and cellular sites, in vitro and in vivo investigations of their biochemical, pharmacological and behavioural actions, laboratory-based and clinical research in humans, substance abuse treatment and prevention research, and studies employing methods from epidemiology, sociology, and economics.
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