Trends and Correlates of Disparities in Alcohol-Related Mortality Between Hispanics and Non-Hispanic Whites in the United States, 1999 to 2014

Racial and ethnic disparities in alcohol-associated liver disease in the United States: A systematic review and meta-analysis

BACKGROUND

Alcohol-associated liver disease (ALD), encompassing alcohol-associated hepatitis and alcohol-associated cirrhosis, is rising in the United States. Racial and ethnic disparities are evident within ALD; however, the precise nature of these disparities is poorly defined.

METHODS

We conducted a search of the PubMed/MEDLINE and EMBASE databases to identify studies published from inception through September 2023 that reported ALD incidence, prevalence, and mortality within the United States, stratified by race and ethnicity. We calculated pooled prevalence and incidence by race and ethnicity, including risk ratios and ORs for ALD pooled prevalence and alcohol-associated hepatitis/alcohol-associated cirrhosis pooled proportions, and OR for ALD mortality using the DerSimonian and Laird method for random-effect models.

RESULTS

We identified 25 relevant studies (16 for quantitative meta-analysis), comprising 76,867,544 patients. ALD prevalence was highest in Hispanic (4.5%), followed by White (3.1%) and Black (1.4%) individuals. Pooled risk ratios of ALD prevalence were 1.64 (95% CI: 1.12-2.39) for Hispanic and 0.59 (95% CI: 0.35-0.87) for Black compared to White individuals. Mortality among those with ALD did not significantly differ between White and Hispanic (OR: 1.54, 95% CI: 0.9-2.5; I2=0%), Black (OR: 1.2, 95% CI: 0.8-1.6; I2=0%), or Native American (OR: 2.41, 95% CI: 0.9-2.9) individuals, while there was a significant difference between White and Asian (OR: 0.1; 95% CI: 0.03-0.5) individuals. Most data were cross-sectional and assessed to be of poor or fair quality.

CONCLUSIONS

Differences were observed in ALD epidemiology, including higher prevalence among Hispanic and lower prevalence among Black individuals, although there were smaller differences in ALD mortality. Differences in ALD prevalence and prognosis remain poorly defined based on existing data, highlighting a need for higher-quality epidemiological studies in this area.

Racial and Ethnic Disparities in Liver Transplantation for Alcohol-associated Liver Diseases in the United States

BACKGROUND

Emerging data suggest disparities exist in liver transplantation (LT) for alcohol-associated liver disease (ALD). As the incidence of ALD increases, we aimed to characterize recent trends in ALD LT frequency and outcomes, including racial and ethnic disparities.

METHODS

Using United Network for Organ Sharing/Organ Procurement and Transplantation Network data (2015 through 2021), we evaluated LT frequency, waitlist mortality, and graft survival among US adults with ALD (alcohol-associated hepatitis [AH] and alcohol-associated cirrhosis [AAC]) stratified by race and ethnicity. We used adjusted competing-risk regression analysis to evaluate waitlist outcomes, Kaplan-Meier analysis to illustrate graft survival, and Cox proportional hazards modeling to identify factors associated with graft survival.

RESULTS

There were 1211 AH and 26 526 AAC new LT waitlist additions, with 970 AH and 15 522 AAC LTs performed. Compared with non-Hispanic White patients (NHWs) with AAC, higher hazards of waitlist death were observed for Hispanic (subdistribution hazard ratio [SHR] = 1.23, 95% confidence interval [CI]: 1.16-1.32), Asian (SHR = 1.22, 95% CI:1. 01-1.47), and American Indian/Alaskan Native (SHR = 1.42, 95% CI: 1.15-1.76) candidates. Similarly, significantly higher graft failures were observed in non-Hispanic Black (HR = 1.32, 95% CI: 1.09-1.61) and American Indian/Alaskan Native (HR = 1.65, 95% CI: 1.15-2.38) patients with AAC than NHWs. We did not observe differences in waitlist or post-LT outcomes by race or ethnicity in AH, although analyses were limited by small subgroups.

CONCLUSIONS

Significant racial and ethnic disparities exist for ALD LT frequency and outcomes in the United States. Compared with NHWs, racial and ethnic minorities with AAC experience increased risk of waitlist mortality and graft failure. Efforts are needed to identify determinants for LT disparities in ALD that can inform intervention strategies.

Use of an Automated Bilingual Digital Health Tool to Reduce Unhealthy Alcohol Use Among Latino Emergency Department Patients: A Randomized Clinical Trial

Importance

Alcohol use disorders have a high disease burden among US Latino groups. In this population, health disparities persist, and high-risk drinking has been increasing. Effective bilingual and culturally adapted brief interventions are needed to identify and reduce disease burden.

Objective

To compare the effectiveness of an automated bilingual computerized alcohol screening and intervention (AB-CASI) digital health tool with standard care for the reduction of alcohol consumption among US adult Latino emergency department (ED) patients with unhealthy drinking.

Design, Setting, and Participants

This bilingual unblinded parallel-group randomized clinical trial evaluated the effectiveness of AB-CASI vs standard care among 840 self-identified adult Latino ED patients with unhealthy drinking (representing the full spectrum of unhealthy drinking). The study was conducted from October 29, 2014, to May 1, 2020, at the ED of a large urban community tertiary care center in the northeastern US that was verified as a level II trauma center by the American College of Surgeons. Data were analyzed from May 14, 2020, to November 24, 2020.

Intervention

Patients randomized to the intervention group received AB-CASI, which included alcohol screening and a structured interactive brief negotiated interview in their preferred language (English or Spanish) while in the ED. Patients randomized to the standard care group received standard emergency medical care, including an informational sheet with recommended primary care follow-up.

Main Outcomes and Measures

The primary outcome was the self-reported number of binge drinking episodes within the last 28 days, assessed by the timeline followback method at 12 months after randomization.

Results

Among 840 self-identified adult Latino ED patients (mean [SD] age, 36.2 [11.2] years; 433 [51.5%] male; and 697 [83.0%] of Puerto Rican descent), 418 were randomized to the AB-CASI group and 422 to the standard care group. A total of 443 patients (52.7%) chose Spanish as their preferred language at enrollment. At 12 months, the number of binge drinking episodes within the last 28 days was significantly lower in those receiving AB-CASI (3.2; 95% CI, 2.7-3.8) vs standard care (4.0; 95% CI, 3.4-4.7; relative difference [RD], 0.79; 95% CI, 0.64-0.99). Alcohol-related adverse health behaviors and consequences were similar between groups. The effect of AB-CASI was modified by age; at 12 months, the relative reduction in the number of binge drinking episodes within the last 28 days in the AB-CASI vs standard care group was 30% in participants older than 25 years (RD, 0.70; 95% CI, 0.54-0.89) compared with an increase of 40% in participants 25 years or younger (RD, 1.40; 95% CI, 0.85-2.31; P = .01 for interaction).

Conclusions and Relevance

In this study, US adult Latino ED patients who received AB-CASI had a significant reduction in the number of binge drinking episodes within the last 28 days at 12 months after randomization. These findings suggest that AB-CASI is a viable brief intervention that overcomes known procedural barriers to ED screening, brief intervention, and referral to treatment and directly addresses alcohol-related health disparities.

Trial Registration

ClinicalTrials.gov Identifier: NCT02247388.

Health disparities in chronic liver disease

The syndemic of hazardous alcohol consumption, opioid use, and obesity has led to important changes in liver disease epidemiology that have exacerbated health disparities. Health disparities occur when plausibly avoidable health differences are experienced by socially disadvantaged populations. Highlighting health disparities, their sources, and consequences in chronic liver disease is fundamental to improving liver health outcomes. There have been large increases in alcohol use disorder in women, racial and ethnic minorities, and those experiencing poverty in the context of poor access to alcohol treatment, leading to increasing rates of alcohol-associated liver diseases. Rising rates of NAFLD and associated fibrosis have been observed in Hispanic persons, women aged > 50, and individuals experiencing food insecurity. Access to viral hepatitis screening and linkage to treatment are suboptimal for racial and ethnic minorities and individuals who are uninsured or underinsured, resulting in greater liver-related mortality and later-stage diagnoses of HCC. Data from more diverse cohorts on autoimmune and cholestatic liver diseases are lacking, supporting the need to study the contemporary epidemiology of these disorders in greater detail. Herein, we review the existing literature on racial and ethnic, gender, and socioeconomic disparities in chronic liver diseases using a social determinants of health framework to better understand how social and structural factors cause health disparities and affect chronic liver disease outcomes. We also propose potential solutions to eliminate disparities, outlining health-policy, health-system, community, and individual solutions to promote equity and improve health outcomes.

The role of resilience in alcohol use, drinking motives, and alcohol-related consequences among Hispanic college students

Background: Hispanic college students experience minority stressors and are therefore at greater risk of experiencing alcohol-related consequences. Resilience may protect against problem drinking and related consequences, yet its relationship to drinking motives remains unexplored. Given that drinking motives precede both alcohol use and its consequences, investigating the role of resilience in such associations may inform interventions to reduce alcohol-related health disparities.Objectives: The current study investigated whether greater resilience predicted fewer drinking motives, lower alcohol consumption, and reduced the negative impact of drinking motives on alcohol consequences among Hispanic college students.Methods: Resilience, drinking motives and alcohol consequences were assessed among 443 students living on the U.S./Mexico border recruited via e-mail (68% female; M_age = 22.6 years, SD = 5.09). Linear regressions assessed whether drinking motives (i.e., coping, conformity, social, enhancement) and resilience predicted alcohol consumption. A linear regression also assessed resilience, drinking motives, and alcohol consumption as potential predictors of alcohol consequences. Lastly, linear regressions tested the moderating effects of resilience between each drinking motive and alcohol consumption as well as alcohol consequences.Results: Greater resilience predicted fewer alcohol-related consequences (β = -.024, p = .028). Additionally, resilience moderated the relationships social (β = -.095, p = .050) and enhancement drinking motives (β = -.084, p = .050) had with alcohol consequences. Higher social and enhancement motives were not associated with alcohol consequences among resilient individuals.Conclusion: Strengthening resilience among Hispanic students whose drinking is motivated by a desire for socialization or mood enhancement may protect against alcohol-related consequences.

A Decade of Drinking: Temporal Trends in Apparent Household Beer Intake and Standard Drink Consumption in the United States

Beer remains the greatest source of per capita alcohol consumption in the United States, and increasing market availability and consumer demand for higher alcohol has meaningful public health consequences. Objectives: To determine whether apparent alcohol intake from beer changed among households over time, we used nationally-representative US Nielsen Consumer Panel purchasing data from 2004 to 2014, and incorporated information on percent alcohol by volume (ABV) to compute the number of standard drinks of alcohol consumed from beer as a result. Methods: We queried external data sources (e.g. official manufacture, consumer beer-related websites) to obtain beer-specific ABVs, merged this information with Nielsen consumer-level data, and calculated the average rate of beer and standard drink consumption per household per year. We used joinpoint regression to estimate annual percentage changes and annual absolute changes in intake over time, with separate piecewise linear segments fit between years if a significant deviation in trend was detected. Results: Higher alcohol content beer consumption increased steadily across the decade, accounting for 9.6% of total intake in 2004 compared to 21.6% of total intake by 2014. Standard drink intake from beer declined sharply post-2011 by 3.04% annually (95% CI: -5.93, -0.06) or by 4.52 standard drinks (95% CI: -8.69, -0.35) yearly - coinciding with several beer industry transitions, market share fluctuations, and consumer preference changes for beer occurring around that time. Conclusions: Despite consistent increases in higher alcohol content beer intake across the decade, households do not appear to be consuming more standard drinks of alcohol from beer as a result.Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2021.1928208 .

Racial and ethnic differences in alcohol-, opioid-, and co-use-related deaths in Washington State from 2011 to 2017

BACKGROUND

Few studies exist examining alcohol and opioid co-use mortality rates among racially and ethnically diverse communities, presenting a critical gap in understanding the contribution of alcohol on opioid-related deaths and strategies for prevention. The purpose of the study was to assess whether alcohol and opioid-related deaths differ by race/ethnicity subgroups and if there has been an increase in alcohol and opioid-related deaths between 2011 and 2017.

DESIGN

Secondary data analysis of publicly available alcohol and opioid mortality data among non-Hispanic Whites, Black, Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native individuals in Washington State.

MEASUREMENTS

The primary outcomes were alcohol-only, opioid-only, and alcohol-opioid co-use mortality, 2011-2017. Alcohol and/or opioid-related deaths were assigned an International Statistical Classification of Diseases and Related Health Problems (ICD-10) code for the underlying or multiple cause of death.

FINDINGS

Between 2011 and 2017, alcohol-only mortality rates increased among non-Hispanic White (P = 0.003) and Hispanic individuals (P = 0.008). Opioid-only mortality rates increased among American Indian/Alaska Native (P = 0.004) and Hispanic individuals (P = <0.001). American Indian/Alaska Native individuals had the highest alcohol-only, opioid-only, and co-use-related mortality rates when looking at between-group incidence rates.

CONCLUSIONS

Although the opioid epidemic has been characterized as a public health crisis that predominantly impacts non-Hispanic White individuals, racial and ethnic minorities are increasingly impacted by fatal and non-fatal overdose related to co-occurring substance use. Our findings using data from Washington State, align with existing data and signal a dire need to address alcohol and opioid misuse through targeted interventions to prevent overdose and poisoning, with special considerations for American Indian/Alaska Native communities.

Alcohol use trajectories of adult Latinx immigrants during their first decade in the United States

BACKGROUND

Despite important research advances on the alcohol use behaviors of Latinx immigrants, the bulk of existing evidence has focused on alcohol use patterns after immigrant's arrival to the US. The present study examines pre- to post immigration alcohol use trajectories among Latinx immigrants of diverse national origins throughout their first decade in the United States.

METHODS

Data for this longitudinal study was collected between 2007 and 2017. At baseline, retrospective pre-immigration alcohol use data was collected on 527 Cuban, South American and Central American participants ages 18-34 who immigrated to the US less than one year prior. Three subsequent follow-up assessments over the past 10 years have collected data on post-immigration alcohol use.

RESULTS

Overall decreases in pre- to post-immigration alcohol use were found. Gender, income, and national origin were associated with distinct drinking patterns after immigration.

CONCLUSION

Findings underscore the importance of examining pre-immigration experiences among Latinx immigrants, in addition to longitudinal alcohol use patterns after immigration. This knowledge is important not only from an epidemiological perspective, but for the development of effective culturally relevant alcohol interventions targeting Latinx immigrants early in the immigration process.

Contemporary Appraisal of Sex Differences in Prevalence, Correlates, and Outcomes of Alcoholic Cardiomyopathy

AIMS

The aims of this study were to: examine differences in alcoholic cardiomyopathy (ACM) prevalence, temporal trends and the distribution of socio-demographic factors and comorbidities by sex; and investigate differences in selected inpatient outcomes between women and men with ACM.

METHODS

We used the 2002-2014 Nationwide Inpatient Sample databases. Overall and sex-specific rates of ACM were estimated across sociodemographic, clinical, and hospital characteristics. Joinpoint regression was used to estimate temporal trends (annual percent change [APC]) of ACM-related hospitalization by sex and race/ethnicity. Adjusted odds ratios (AOR) representing associations between sex and selected ACM outcomes were calculated using survey logistic regression.

RESULTS

The rate of ACM among all inpatient men and women was 128 per 100,000 and 17 per 100,000 hospitalizations, respectively. Among women, the rate of ACM remained unchanged during the study period, while for men, there was 1.2% annual reduction from 2002-2010 (APC -1.3, 95% CI: -1.7, -0.8). Women with ACM were more likely than men with ACM to experience depression (AOR=2.24, 95% CI: 2.06-2.43) and anxiety (AOR=1.94, 95% CI: 1.75-2.15), while men with ACM were 21% and 24% more likely than women with ACM to experience 'any heart failure (HF)' and HF with reduced ejection fraction respectively. One in 1,471 hospitalizations were related to ACM with a male-to-female ratio of 8:1.

CONCLUSION

Individuals with ACM are at increased likelihood of adverse outcomes. Women with ACM are at increased risk of depression and anxiety, while men are at increased risk of HF.

Parsing the Paradox: Hispanic Mortality in the US by Detailed Cause of Death

US Hispanics are a disadvantaged population that paradoxically has lower mortality rates than non-Hispanic whites. We conducted a descriptive analysis of age-adjusted mortality rates for 113 causes of death for US Hispanics (USH) and US non-Hispanic whites (USNHW) during 1999-2015. All-cause, age-adjusted mortality rates per 100,000 were: 581.1 USH and 788.8 USNHW. Lower Hispanic mortality from cancer, heart disease, and respiratory disease accounted for almost all the all-cause mortality gap. USH rates were higher than USNHW rates for cancers of the stomach, liver, and cervix; diabetes mellitus; liver disease; and homicide. Behavioural factors such as less smoking among USH probably drive their lower rates for the major chronic diseases. Social disadvantages contribute to elevated risk for certain cancers, diabetes, and homicide. Efforts to improve Hispanic well-being in the US should remedy the social disadvantages while preserving the health advantages the population enjoys.