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Disparities in pharmacotherapy for alcohol use disorder in the context of universal health care
A Swedish register study
Karriker-Jaffe, K. J., Ji, J., Sundquist, J., Kendler, K. S., & Sundquist, K. (2017). Disparities in pharmacotherapy for alcohol use disorder in the context of universal health care: A Swedish register study. Addiction, (8). https://doi.org/10.1111/add.13834
Background and aimsPharmacotherapy can be an important part of the continuum of care for alcohol use disorder (AUD). The Swedish universal health-care system emphasizes provision of care to marginalized groups. The primary aim was to test associations of neighborhood deprivation and disadvantaged social status with receipt of AUD pharmacotherapy in this context.
DesignData from linked population registers were used to follow an open cohort over 7years.
SettingSweden.
ParticipantsAlcohol-related ICD-10 codes reported for all hospitalizations in the Swedish Hospital Discharge Register and all clinic/office visits in the Outpatient Care Register between 2005 and 2012 were used to identify 62549 cases with AUD.
MeasurementsThe primary outcome was any AUD pharmacotherapy (naltrexone, disulfiram, acamprosate, nalmefene) picked up by patients between 2005 and 2012 (versus none), based on the Swedish Prescribed Drug Register. Neighborhood deprivation was defined using aggregated data from the Total Population Register; indicators of disadvantaged social status (income, education, country of origin) also came from this source.
FindingsApproximately half the cases (53.7%) picked up one or more AUD pharmacotherapy prescriptions. In adjusted models, people living in neighborhoods with moderate [odds ratio (OR)=0.90, 95% confidence interval (CI)=0.86, 0.95] or high levels of deprivation (OR=0.75, 95% CI=0.70, 0.79) compared with low deprivation, those with lower incomes (for example, lowest quartile: OR=0.70, 95% CI=0.66, 0.73 compared with highest) and less education (for example,
ConclusionsThere appear to be socio-economic disparities in the receipt of pharmacotherapy for alcohol use disorder in Sweden.
