Limited treatment accessibility: Implications for alcohol treatment disparities among Mexican Americans living in the U.S.-Mexico border region

A scoping review of health inequities in alcohol use disorder

Background: Alcohol Use Disorder (AUD) poses a significant health burden on individuals. The burden occurs more frequently in the medically underserved, as well as racial and sexual minority populations. Ameliorating health inequities is vital to improving patient-centered care.Objectives: The objective of this scoping review is to chart the existing evidence on health inequities related to AUD and identify existing knowledge gaps to guide future equity-centered research.Methods: We performed a literature search using the Ovid (Embase) and MEDLINE (PubMed) databases for articles on AUD that were published in the 5-year period spanning from 2017 to 2021 and written in English. The frequencies of each health inequity examined were analyzed, and findings from each included study were summarized.Results: Our sample consisted of 55 studies for analysis. The most common inequity examined was by race/ethnicity followed by sex or gender. The least reported inequities examined were rural under-resourced areas and occupational status. Our findings indicate that significant research gaps exist in education, rural under-resourced populations, and LGBTQ+ communities with AUD.Conclusions: This scoping review highlights the gaps in research on inequities in AUD. To bridge the current gaps, we recommend research on the following: 1) triage screening tools and the use of telemedicine for rural, under-resourced populations; 2) interventions to increase treatment engagement and retention for women; and 3) community-based participatory methodologies for the LGBTQ+ communities.

Alcohol- and Drug-Related Mortality Among Adults Within and Outside the U.S.-Mexico Border Region

OBJECTIVE

Although researchers and policy makers have often considered the U.S.-Mexico border region to be at high risk for substance use problems, epidemiological studies of this region have been hard to interpret because of their modest geographic coverage, reliance on self-report, and mixed results. The current study addresses limitations of existing studies and extends the knowledge base by comparing alcohol- and drug-related mortality in counties on versus off the border across all four U.S. border states.

METHOD

Data were from the 2008-2017 Centers for Disease Control and Prevention WONDER Multiple Causes of Death data set, American Community Survey, and Rural Urban Continuum Codes, including all four border states. Spatial lag models tested differences across on- and off-border counties in total alcohol- and drug-related mortality ("total mortality"), alcohol-related mortality, and drug-related mortality.

RESULTS

In multivariate models, mortality rates were significantly higher in off- versus on-border counties for all three outcomes (ps < .05). Rates for total mortality, alcohol-related mortality, and drug-related mortality were 28%, 82%, and 30% higher, respectively, off versus on the border. Border effects were similar, excluding California; robust over time; and stronger for Latinx versus White decedents.

CONCLUSIONS

Results suggest a revised understanding of the border, revealing that residents of interior counties of border states are at highest risk of severe substance use consequences. Results are consistent with other research finding that border counties were protected against drug overdose deaths, particularly for Latinx residents.

Alcohol- and Drug-Related Mortality Among Adults Within and Outside the U.S.-Mexico Border Region

OBJECTIVE

Although researchers and policy makers have often considered the U.S.-Mexico border region to be at high risk for substance use problems, epidemiological studies of this region have been hard to interpret because of their modest geographic coverage, reliance on self-report, and mixed results. The current study addresses limitations of existing studies and extends the knowledge base by comparing alcohol- and drug-related mortality in counties on versus off the border across all four U.S. border states.

METHOD

Data were from the 2008-2017 Centers for Disease Control and Prevention WONDER Multiple Causes of Death data set, American Community Survey, and Rural Urban Continuum Codes, including all four border states. Spatial lag models tested differences across on- and off-border counties in total alcohol- and drug-related mortality ("total mortality"), alcohol-related mortality, and drug-related mortality.

RESULTS

In multivariate models, mortality rates were significantly higher in off- versus on-border counties for all three outcomes (ps < .05). Rates for total mortality, alcohol-related mortality, and drug-related mortality were 28%, 82%, and 30% higher, respectively, off versus on the border. Border effects were similar, excluding California; robust over time; and stronger for Latinx versus White decedents.

CONCLUSIONS

Results suggest a revised understanding of the border, revealing that residents of interior counties of border states are at highest risk of severe substance use consequences. Results are consistent with other research finding that border counties were protected against drug overdose deaths, particularly for Latinx residents.