马萨诸塞州阿片类药物使用障碍患者从急性后护理机构转诊拒绝方面的种族和族裔差异。
Racial and Ethnic Disparities in Referral Rejection From Postacute Care Facilities Among People With Opioid Use Disorder in Massachusetts.
作者信息
Rosenmoss Sophie, LaRochelle Marc, Bearnot Benjamin, Weinstein Zoe, So-Armah Kaku, Moyo Patience, Yan Shapei, Walley Alexander Y, Kimmel Simeon D
机构信息
From the Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA (SR, ML, ZW, KS-A, SY, AYW, SDK); Department of Medicine, University of California Los Angeles, Los Angeles, CA (SR); The Grayken Center for Addiction, Boston Medical Center, Boston, MA (ML, ZW, AYW, SDK); Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA (BB); Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI (PM); and Section of Infectious Diseases, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA (SDK).
出版信息
J Addict Med. 2025;19(2):165-171. doi: 10.1097/ADM.0000000000001390. Epub 2024 Nov 8.
OBJECTIVES
The aim of the study was to examine the association between Black, White, and Hispanic or Latino race and ethnicity and referral rejection from private postacute care facilities among hospitalized individuals with opioid use disorder (OUD).
METHODS
In this retrospective cohort study, we linked electronic postacute care referrals from Boston Medical Center in 2018 to electronic medical record data, which we used to ascertain OUD status and race and ethnicity. Using multivariable logistic regression, we examined the association between Black, White, and Hispanic or Latino race and ethnicity and referral rejection, adjusting for individual-level characteristics including medication for opioid use disorder treatment type and for facility-level factors using facility random effects.
RESULTS
We identified 159 hospitalizations from 141 individuals with OUD referred to private postacute medical care, corresponding to 1272 referrals to 244 facilities. Hospitalizations comprised 53 (33%) non-Hispanic Black, 28 (18%) Hispanic or Latino, and 78 (49%) non-Hispanic White individuals. In adjusted analyses, referrals for non-Hispanic Black individuals had significantly higher odds of rejection compared to referrals for non-Hispanic White individuals (adjusted odds ratio 1.83, 95% confidence interval [1.24, 2.69], P = 0.002). There were no significant differences between referrals for Hispanic or Latino individuals and non-Hispanic White individuals (adjusted odds ratio 1.11, 95% confidence interval [0.67, 1.84], P = 0.69).
CONCLUSIONS
Among people with OUD referred to private postacute care in Massachusetts, non-Hispanic Black individuals were more likely to be rejected compared to non-Hispanic White individuals, demonstrating racism in postacute care admissions. Efforts to address discrimination against people with OUD in postacute care admissions must also address racial equity.
目的
本研究旨在探讨黑人、白人以及西班牙裔或拉丁裔种族与族裔与阿片类药物使用障碍（OUD）住院患者被私立急性后护理机构拒绝转诊之间的关联。
方法
在这项回顾性队列研究中，我们将2018年波士顿医疗中心的电子急性后护理转诊信息与电子病历数据相链接，后者用于确定OUD状态以及种族与族裔。我们使用多变量逻辑回归分析，研究黑人、白人以及西班牙裔或拉丁裔种族与族裔和转诊被拒之间的关联，并对个体层面的特征（包括阿片类药物使用障碍治疗类型的药物）以及机构层面的因素（采用机构随机效应）进行调整。
结果
我们确定了141名患有OUD的个体被转诊至私立急性后医疗护理机构的159次住院情况，对应向244家机构的1272次转诊。住院患者包括53名（33%）非西班牙裔黑人、28名（18%）西班牙裔或拉丁裔以及78名（49%）非西班牙裔白人个体。在调整分析中，与非西班牙裔白人个体的转诊相比，非西班牙裔黑人个体的转诊被拒几率显著更高（调整后的优势比为1.83，95%置信区间[1.24, 2.69]，P = 0.002）。西班牙裔或拉丁裔个体的转诊与非西班牙裔白人个体的转诊之间无显著差异（调整后的优势比为1.11，95%置信区间[0.67, 1.84]，P = 0.69）。
结论
在马萨诸塞州被转诊至私立急性后护理机构的OUD患者中，非西班牙裔黑人个体比非西班牙裔白人个体更有可能被拒，这表明急性后护理入院存在种族主义。解决急性后护理入院中对OUD患者的歧视问题的努力也必须解决种族公平问题。
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