Assessing inequities in buprenorphine treatment across the care cascade

IF 3.9 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence Pub Date : 2025-02-28 DOI:10.1016/j.drugalcdep.2025.112636

Alyssa S. Tilhou , Sarah Gasman , Jiayi Wang , Katherine Standish , Laura F. White , Ally Cogan , Morgan Devlin , Marc Larochelle , William G. Adams

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引用次数: 0

Abstract

Objective

Describe buprenorphine treatment gaps across the care cascade by race, ethnicity, age, sex and key clinical characteristics.

Design

Observational cohort study of new opioid use disorder (OUD) treatment episodes, 1/1/15–12/31/21

Participants

Individuals 16–89 years at Boston Medical Center and affiliated Boston-area clinics with OUD or buprenorphine prescription following 90-day washout

Main outcomes and measures

Buprenorphine initiation (by 14d), engagement (second prescription by 34d), and retention (continuous buprenorphine through 180d without >14d gap). Covariates: sex, race and ethnicity, age, past 12-month buprenorphine, past 12-month overdose, co-occurring substance use disorder (SUD) and psychiatric diagnosis.

Results

24,165 episodes (14,182 individuals) included the following characteristics: female (34.1 %); Black (21.5 %), Latino (16.2 %), White (59.2 %); 16–25 years (4.1 %), 65–89 years (4.9 %). Initiation, engagement and retention were low: 39.3 %, 19.3 %, and 12.4 %. In adjusted models, compared with males, females’ lower probability of overall retention reflected lower engagement conditional on initiation (41 % vs. 53 %; OR:0.61, 95 %CI:0.56–0.67, p < 0.001). Black individuals’ lower probability of retention overall reflected lower initiation than White individuals (28 % vs 44 %; OR:0.50, 95 %CI:0.46–0.55, p < 0.001). The retention disadvantage for younger and older groups reflected cascade-wide gaps. Lower overall retention associated with co-occurring SUDs reflected lower initiation (OUD only:46 %; OUD plus: alcohol:19 % OR:0.27, 95 %CI:0.21–0.34, p < 0.001; sedatives:21 %, OR:0.31, 95 %CI:0.20–0.49, p < 0.001; stimulants:25 %, OR:0.40, 95 %CI:0.33–0.48, p < 0.001; ≥3 SUDs:25 %, OR:0.40, 95 %CI:0.37–0.43, p < 0.001).

Conclusions and relevance

Inequities in buprenorphine use emerged across the care cascade with unique patterns by sociodemographic and clinical subgroup. Health systems aiming to reduce buprenorphine inequities should identify the optimal cascade step based on the population of interest.

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评估整个护理级联中丁丙诺啡治疗的不公平

目的按种族、民族、年龄、性别和主要临床特征描述丁丙诺啡在护理级联中的治疗差距。设计：新的阿片类药物使用障碍（OUD）治疗事件的观察性队列研究，1/1/15 - 12/31/21参与者在波士顿医疗中心及其附属波士顿地区诊所接受OUD或丁丙诺啡处方的16-89岁个体，经过90天的洗脱期。主要结果和测量丁丙诺啡开始（14d），参与（第二次处方34d）和保留（连续使用丁丙诺啡180d，无14d间隔）。协变量：性别，种族和民族，年龄，过去12个月丁丙诺啡，过去12个月过量，共同发生的物质使用障碍（SUD）和精神诊断。结果24165例（14182人）包括以下特征：女性（34.1%）；黑人（21.5%），拉丁裔（16.2%），白人（59.2%）；16-25岁（4.1%），65-89岁（4.9%）。入门率、粘性和留存率较低，分别为39.3%、19.3%和12.4%。在调整后的模型中，与男性相比，女性较低的总体留存率反映了较低的初始粘性条件(41% vs. 53%；OR:0.61, 95% CI: 0.56-0.67, p < 0.001)。黑人个体总体上较低的保留率反映了比白人个体更低的起始率(28%比44%；OR:0.50, 95% CI: 0.46-0.55, p < 0.001)。年轻和年长群体的留任劣势反映了级联范围内的差距。与并发sud相关的较低的总体保留率反映了较低的起始率(仅OUD: 46%；乌得琴+:酒精:19%或:0.27,95%置信区间CI: 0.21 - -0.34, p & lt; 0.001;镇静剂:21%,即:0.31,95%置信区间CI: 0.20 - -0.49, p & lt; 0.001;兴奋剂:25%,即:0.40,95%置信区间CI: 0.33 - -0.48, p & lt; 0.001;≥3泡沫:25%,即:0.40,95%置信区间CI: 0.37 - -0.43, p & lt; 0.001)。结论和相关性丁丙诺啡使用的不公平出现在整个护理级联中，具有独特的社会人口统计学和临床亚组模式。旨在减少丁丙诺啡不公平的卫生系统应根据感兴趣的人群确定最佳级联步骤。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

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.