Variations in documentation of alcohol use disorder (AUD) diagnoses across race, ethnicity, and sex in a health system that assesses AUD symptoms as part of routine primary care

Abstract

Introduction

Prior studies have highlighted potential inequities in provider-documented alcohol use disorder (AUD) across race, ethnicity, and sex. Whether subgroup differences in AUD reflect true variation or diagnostic disparities is unknown. This study aims to describe variations in the prevalence of provider-documented AUD across race, ethnicity, and sex: 1) after adjustment for alcohol consumption, and 2) after additional adjustment for patient-reported AUD symptoms.

Methods

In Kaiser Permanente Washington, patients with high-risk drinking (AUDIT-C score 7–12; 2.4 % of screened patients) complete a validated Alcohol Symptom Checklist of DSM-5 AUD symptoms with results documented in electronic health records. This study included Asian, Black, Latine, and White patients in primary care settings (03/2015–02/2022) who indicated high-risk drinking and thus completed an Alcohol Symptom Checklist. The prevalence of AUD was estimated for women and men across race or ethnic groups using marginally standardized generalized linear models. Models were first unadjusted, then adjusted for consumption (AUDIT-C scores 7–12), and then consumption plus AUD symptom counts (0−11).

Results

Among 14,442 patients with high-risk drinking (6.0 % Asian, 5.8 % Black, 7.8 % Latine, 80.4 % White; 32.1 % women), provider-documented AUD increased with alcohol consumption and the number of AUD symptoms. The prevalence of AUD across 8 subgroups defined by race, ethnicity, and sex varied in analyses adjusted for alcohol consumption alone (range 11.6 % [95 % CI: 9.3–14.4] to 20.2 % [18.9–21.5]). However, after adjustment for both alcohol consumption and AUD symptoms, the prevalence of AUD ranged from 11.2 % [95 % CI: 7.9–15.6] to 15.0 % [95 % CI: 13.9–16.3] in women, and from 11.0 % [95 % CI: 8.7–13.8] to 15.1 % [95 % CI: 14.3–16.0] in men. AUD did not appear to vary across race or ethnicity.

Conclusions

In this study of primary care patients with high-risk drinking in a regional healthcare system that routinely assesses AUD symptoms, variations in provider-documented AUD diagnosis across race, ethnicity, and sex were observed after adjusting for alcohol consumption but were diminished after adjusting for AUD symptoms. This may suggest that among patients with similar alcohol consumption and AUD symptoms, intersectional variations in AUD diagnosis may be less apparent. Assessing AUD severity with Alcohol Symptom Checklists may help support equitable clinical AUD diagnosing.